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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.

Identifying and attending to the existential needs of persons with serious illness and their care partners are integral to whole-person palliative care (PC). Yet, many PC clinicians, due to individual factors and wider systemic barriers, are ill-prepared and under-resourced to navigate the existential dimension. In this article, written from clinical, research, and lived experiences, we offer tips to empower PC clinicians to understand, recognize, and respond to patients' and care partners' existential experiences by leveraging their existing skills, collaborating closely with colleagues, exploring their own existential experience, and implementing evidence-based interventions. We propose that by prioritizing existential care within PC, we can shift the culture of health care to better affirm the humanity of both patients and clinicians. [ABSTRACT FROM AUTHOR]

Background: The present study explored the acceptability of psilocybin‐assisted group therapy from the perspective of patients with cancer and depression who participated in a clinical trial assessing the safety and efficacy of this novel intervention. Methods: Guided by the conceptual framework of acceptability, the authors conducted semi‐structured interviews with participants of the psilocybin trial. Data were analyzed using template and thematic analyses. Results: Participants' (n = 28) perspectives on the acceptability of the group and simultaneous sessions was generally positive, both in terms of safety and efficacy: first, the groups contributed to increase participants' sense of safety and preparedness as they were engaging in the therapy; and second, the groups fostered a sense of connection and of belonging, which served to enrich and deepen the meaning of participants' experience, ultimately opening a dimension of self‐transcendence and compassion. Other subthemes related to factors influencing the acceptability of the group approach included: 1) the importance of the therapeutic framework, 2) the complementary value of individual sessions, 3) disruptive factors related to the group and/or simultaneous setting, and 4) opportunities and challenges related to group size and how to structure interactions. Conclusions: This study enhances understanding of what promotes acceptability of the psilocybin‐assisted therapy group model for the treatment of MDD in cancer patients. Plain Language Summary: We conducted exit interviews with participants of a phase 2 trial of psilocybin‐assisted therapy (PAT) conducted in a community cancer center, to assess the acceptability of a novel psilocybin delivery model combining simultaneous individual therapy and group sessions.Our findings support the acceptability of this intervention and suggest that in addition to being feasible, it might also enhance participants' perceived safety and efficacy compared to uniquely individual or group delivery models of PAT.Our analysis highlights critical factors conditioning acceptability and suggests new ways PAT may be scaled and integrated into cancer care. Psilocybin‐assisted group therapy to treat depression in patients with cancer is acceptable and might enhance safety and efficacy. The findings of this study highlight critical factors conditioning acceptability of the group model and suggest new ways psilocybin‐assisted therapy may be scaled and integrated into cancer care. [ABSTRACT FROM AUTHOR]

Within the United States, approximately 330 000 military veterans die annually, but only 5% of deaths occur in Veterans Health Administration (VHA) facilities. To help provide end-of-life care for veterans, the VHA built community partnerships with community hospice and palliative care (HPC) organizations. Veterans experience unique psychosocial factors making it vital to ensure HPC organizations have access to veteran-specific knowledge and resources to reduce suffering. To better understand the strengths and limitations of these partnerships, community HPC staff (N = 483) responded to quantitative and qualitative survey questions developed using an access to care theory for veterans. Survey responses demonstrated variable perceptions of access to VHA care and resources. Respondents reported excellent experiences (44%) and relationships with their local facility (50%) and had a reliable contact who provided needed assistance (92%). Thematic analysis identified a need for VHA care and barriers to access, which were associated with technical characteristics, and geographical and cultural issues. These findings can help inform future research and policy regarding access to VHAresources for end-of-life care for veterans in the community and guide resource development for community HPC providers. [ABSTRACT FROM AUTHOR]

Nurses play an essential role in managing mental health conditions, such as posttraumatic stress disorder (PTSD), especially in rural areas where access to mental health care is limited. Posttraumatic stress disorder may emerge at the end of life and complicate health care and is a particular concern for aging Vietnam veterans. We describe the development of 3 videos that illustrate how to recognize PTSD, respond to trauma disclosures, and manage PTSD in cognitive impairment during an in-home hospice nurse visit. Through problem identification and needs assessment, we identified 6 goals and 28 specific content objectives presented through cinematic action with flashbacks or voice-over narration with graphics. Videos were evaluated through a survey (N = 155) and analysis of "chat" responses (N = 186) to targeted questions during a webinar presentation to clinicians (N = 345). Approximately 75% rated videos as "very much" relevant to needs, having helped learn something new, and realistic. Analysis of chat responses showed videos conveyed most content objectives (92%). In addition, participants stated videos were helpful in demonstrating nursing skills of listening, responding, and displaying empathy, as well as showing case presentations involving cognitive impairment and the patient experience. Participants expressed a desire for longer videos/more information including a wider range of PTSD presentations and comorbidities. [ABSTRACT FROM AUTHOR]

1. Identify patients who would benefit from a trial of buprenorphine low-dose initiation. 2. Review approaches to performing a buprenorphine low-dose initiation to decrease total opioid use in patients with cancer and non-cancer-related pain. Buprenorphine low-dose initiation is a novel approach that harnesses the unique pharmacological profile of this partial-opioid agonist to reduce both risk of precipitated opioid withdrawal and need for prolonged opioid tapers in vulnerable patients. Buprenorphine low-dose initiation is a novel approach that harnesses the unique pharmacological profile of this partial-opioid agonist to reduce both risk of precipitated opioid withdrawal and need for prolonged opioid tapers in vulnerable patients (1). A 65-year-old man with metastatic bladder cancer and significant non-cancer-related orthopedic spine concerns is followed in the palliative care clinic for both cancer and non-cancer-related pain. He was being treated with a multimodal pharmacologic approach, involving opioid therapy (hydromorphone 8mg every 4 hours), neuropathic agents (amitriptyline and pregabalin), muscle relaxants (baclofen), and anti-inflammatory agents (celecoxib). With this, he had recently noted improvement in his pain level and had a desire to wean opioids due to bothersome side-effects of fatigue, cognitive fogging, and occasional myoclonus. Given his chronic opioid use, a rotation to buprenorphine was performed using a low-dose initiation protocol with subutex (buprenorphine tablets). The patient successfully weaned his opioid use from 48mg oral hydromorphone daily to 12mg oral subutex with resolution of his opioid side-effects. Buprenorphine low-dose initiation involves adding increasing low-dose formulations of buprenorphine to an amount where the opioid receptors are nearly fully occupied, then reducing the frequency and dose of full-agonist opioids. In patients with both chronic non-cancer-related and cancer-related pain, this strategy can provide relief from opioid-related side effects, while still achieving good pain control. Evidence supports the use of buprenorphine rotation to reduce chronic pain, without precipitating opioid withdrawal or other serious adverse side effects (2). Managing Suffering and Distress / Pharmacotherapeutics / Pharmacopalliation [ABSTRACT FROM AUTHOR]

At the end of life, individuals may re-engage with earlier life trauma as they reflect on life experiences and confront their mortality. As such, posttraumatic stress disorder (PTSD) symptoms at the end of life may worsen the quality of death experience. This is a concern for military veterans, who tend to have more trauma exposures and higher rates of PTSD, and particularly for veterans receiving care in rural areas where access to PTSD specialty services is limited. To better understand this issue, we conducted 10 focus groups with clinicians serving veterans in rural communities across five U.S. states. The aims of this project were to evaluate: (1) do hospice and palliative care providers/staff observe PTSD symptoms in veterans at the end of life? (2) if so, how are symptoms similar to and different from existing DSM-5 criteria for PTSD? We used qualitative content analysis with mixed deductive and inductive approaches to code 151 anonymized statements. Analyses found descriptions of PTSD symptoms aligned broadly with existing diagnostic nomenclature, but descriptions revealed specific presentations relevant to the end of life setting such as resistance to care, agitation, restlessness, and effects of delirium. In addition, some veterans expressed pride in service and openness to discussing military experiences. Further, clinicians noted that PTSD symptoms were relevant to family dynamics. Future research should further characterize these symptom differences through direct patient assessment and develop resources to improve quality of death experience for veterans with PTSD symptoms. [ABSTRACT FROM AUTHOR]

The article discusses the low-dose initiation method in which there is a period of concomitant high affinity partial mu-opioid agonist buprenorphine and full agonist opioid administration. It mentions that with a low-dose initiation, full agonist opioids should be continued until buprenorphine titration reaches a threshold of opioid receptor activity to minimize the risk of opioid withdrawal symptoms.

Persons without family or friends to serve as healthcare agents may become "unrepresented" in healthcare, with no one to serve as healthcare agents when decisional support is needed. Surveys of clinicians (N = 81) and attorneys/guardians (N = 23) in Massachusetts reveal that unrepresented adults experience prolonged hospital stays (66%), delays in receiving palliative care (52%), delays in treatment (49%), and other negative consequences. Clinicians say guardianship is most helpful in resolving issues related to care transitions, medical treatment, quality of life, housing, finances, and safety. However, experiences with guardianship are varied, with delays often/always in court appointments (43%) and actions after appointments (24%). Policy solutions include legal reform, education, and alternate models. [ABSTRACT FROM AUTHOR]

Background: The majority of Palliative Care (PC) clinicians report recently caring for a person with a Substance Use Disorder (SUD). The impact of an untreated SUD is associated with significant suffering but many PC clinicians report a lack of confidence in managing this population. Objective: This paper aims to demonstrate existing PC skills that can be adapted to provide primary SUD treatment. Methods: A comprehensive literature review was conducted on quality PC domains and core SUD treatment principles. To demonstrate the shared philosophy and skills of PC clinicians and SUD treatment, the National Consensus Project Clinical Practice Guidelines for Quality Palliative Care and resources outlining core Addiction Medicine and Nursing Competencies were used. Results: There is an abundance of overlapping domains in PC and SUD treatment. This paper focuses on the domains of communication, team-based care, quality of life considerations, addressing social determinants of health, and adherence to ethical principles. In each section, the shared domain in PC and SUD treatment is discussed and steps to expand PC clinician's skills are provided. Conclusion: PC clinicians may be among the last healthcare touchpoint for persons with SUD, by naming the shared skills required in PC and evidenced-based SUD treatment, we challenge the field to undertake primary SUD treatment as part of its constant pursuit to better serve people living with serious illness. [ABSTRACT FROM AUTHOR]