Mapping an Agenda for Psychedelic-Assisted Therapy Research in Patients with Serious Illness

This paper (2021) represents the outcomes of several brainstorming sessions, interviews, etc. with many of the leading psychedelic researchers that maps out the direction that the field may take with regards to the use of psychedelics for those with serious illness (end-of-life care).

Abstract

“Background: With support from the Radcliffe Institute for Advanced Study at Harvard University, we convened researchers representing palliative care, psychosocial oncology, spiritual care, oncology, and psychedelic-assisted therapies. We aimed to define priorities and envision an agenda for future research on psychedelic-assisted therapies in patients with serious illness. Over two days in January 2020, participants engaged in an iterative series of reflective exercises that elicited their attitude and perspectives on scientific opportunities for this research. 

Objectives: The aim of the study is to identify themes that shape priorities and an agenda for research on psychedelic-assisted therapy for those affected by serious illness. 

Methods: We collected data through preconference interviews, audio recordings, flip charts, and sticky notes. We applied thematic qualitative analysis to elucidate key themes. 

Results: We identified seven key opportunities to advance the field of psychedelic-assisted therapies in serious illness care. Four opportunities were related to the science and design of psychedelic-assisted therapies: clarifying indications; developing and refining therapeutic protocols; investigating the impact of set and setting on therapeutic outcomes; and understanding the mechanisms of action. The other three pertained to institutional and societal drivers to support optimal and responsible research: education and certification for therapists; regulations and funding; and diversity and inclusion. Additionally, participants suggested epistemological limitations of the medical model to understand the potential value and therapeutic use of psychedelics. 

Conclusions: Medicine and society are witnessing a resurgence of interest in the effects and applications of psychedelic-assisted therapies in a wide range of settings. This article suggests key opportunities for research in psychedelic-assisted therapies for those affected by serious illness.”

Authors: Yvan Beaussant, James Tulsky, Benjamin Guérin, Claudia Schwarz-Plaschg & Justin J Sanders

Summary

Researchers convened at Harvard University to define priorities and envision an agenda for future research on psychedelic-assisted therapies in patients with serious illness.

Introduction

Patients with serious illness commonly experience psychological, existential, and spiritual distress, which negatively impacts their quality of life and other health care outcomes.

Psychedelic-assisted therapies have gained interest as a potential novel therapeutic modality because preliminary evidence suggests they can improve psychological, existential, and spiritual outcomes in seriously ill patients.

Experts in serious illness care are hopeful about psychedelic-assisted therapies, but are concerned about adverse effects and ethical issues. They advocate for rigorous research integrated with high-quality psychosocial and palliative care.

To facilitate a concerted, interdisciplinary, and international research effort on psychedelic-assisted therapies in patients with serious illness, we convened an exploratory seminar.

Seminar design and agenda

The Radcliffe Institute for Advanced Study at Harvard University hosted a seminar on psilocybin for cancer patients in January 2020.

Before the meeting, participants had phone interviews to review the state of the science and define priorities.

Based on findings from our study, we designed a seminar agenda to elicit participant attitudes and perspectives on scientific opportunities and priorities for psychedelic research in serious illness.

Data collection, analysis, and reporting

All large and half-group sessions were audio recorded, and flip charts and sticky notes were used to document the discussion. One of the authors categorized the recorded data by theme, and the article was reviewed by all participants.

Results

We identified seven topic areas for future research on psychedelic-assisted therapies in serious illness care, including patient and caregiver outcomes, therapeutic protocols, therapeutic setting, and mechanisms of action.

Design and science of psychedelic-assisted therapies

Participants discussed numerous psychosocial and palliative care outcomes as potential therapeutic targets for psychedelic-assisted therapy, and called for a concerted effort to standardize outcome measures across studies.

Participants expressed interest in the potential for psychedelic-assisted therapies to address the existential and spiritual dimensions of suffering experienced by patients with serious illness. They also raised the possibility that caregiver outcomes might be affected by psychedelic-assisted therapies.

Participants suggested that shorter-acting psychedelics, such as dimethyltryptamine or ketamine, might be useful in the setting of serious illness care, and that studies should compare psychedelic medications with each other and with current standards of care.

Participants suggested combining psychedelic-assisted therapies with existing evidence-based psychotherapeutic approaches in serious illness care, and considered their potential role alongside spiritual care interventions. They also suggested researching the relative effects of various modalities, such as individual therapy, group therapy, or conjoint therapy.

Participants highlighted the need for research to help refine standards for optimal therapeutic settings for people affected by serious illness.

Integrating psychedelic research into interdisciplinary care models emerged as a major theme of this seminar. Participants specified criteria they considered most important for treatment spaces, including comfortable, quiet, safe, and esthetic rooms separated from other activities in the building and equipped with audio systems.

Participants were concerned that inappropriate and harmful settings might result from the reopening of psychedelic research in patients with serious illness, but were equally concerned that the cost might constitute a factor of inequality.

Participants suggested that further research is needed to better understand psychedelic-assisted therapy mechanisms of action in the context of serious illness care, and called for the use of translational designs and mixed methods involving interdisciplinary teams.

Institutional and societal drivers

Integrate education and certification for therapists. Regulatory changes are expected to be supportive of psychedelic research in the near future, and a need for health care professionals trained in psychedelic-assisted therapies and serious illness care will grow.

Participants discussed the relevance of therapists’ first-hand experience of psychedelics, and suggested that policy updates should be considered to support this aspect of the training of future therapists.

Participants suggested that regulatory agencies should be involved early in the development of research protocols to collect data in ways that support regulatory approval, and that funding should be tied to studies being inclusive and proportionate re: minority participant populations and study staff.

Participants suggested ways to make psychedelic research inclusive of diverse and underserved populations, such as by involving more therapists of color, including nontraditional sites with more diverse populations, or enabling access through coverage by all major insurances and charitable care for anyone.

and the medical model

This seminar discussed the potential of psychedelic-assisted therapy as a biomedical intervention for patients with serious illness. Participants agreed that a mechanistic approach to health and science is needed.

Participants questioned the appropriateness of the sole medical model to approach the science and therapeutic use of psychedelics, and the value of pathologizing the spiritual or existential dimension of suffering. They also questioned the validity of considering psychedelic-assisted therapy as a biomedical intervention.

Discussion

This article highlights findings from a two-day symposium hosted by the Radcliffe Institute for Advanced Study at Harvard University, which included 23 clinicians, researchers, and one patient. The participants described key opportunities for research at the intersection between serious illness care and psychedelic-assisted therapies. These findings are in accordance with a previous qualitative exploration of experts’ perspective on the potential role of psychedelic-assisted therapies in patients with serious illness, and underscore further the potential clinical need for psychedelic therapies.

Participants raised fundamental questions about the potential limits of applying a biomedical model to aspects of psychedelic research that may lie outside traditional scientific frameworks. These issues have challenged anthropologists and practitioners of palliative care and psychedelic medicine.

The spiritual dimension of psychedelic-assisted therapies in the context of serious illness is reflected in surveys and qualitative research reporting cancer patients’ experiences. This research suggests that more work needs to be done to discern important outcomes, measures, and implementation strategies.

Limitations

Our attempt to include a well-rounded cohort of key stakeholders was limited by the absence of voices of nurses, spiritual care providers, representatives of indigenous groups, the pharmaceutical industry, and regulatory/funding agencies.

Conclusions

Participants identified key opportunities to advance psychedelic research in patients with serious illness, including the understanding of patient and family experiences and needs at the end of life, and the integration of psychedelic-assisted therapies into serious illness care practices.

Acknowledgments

The project team is grateful to the Radcliffe Institute for Advanced Study at Harvard University, the seminar participants, and the Boston Psychedelic Research Group for their support.