Background Psychedelic therapies for treatment of treatment-resistant depression (TRD), and PTSD garner high interest (e.g. New England Journal, Cochrane, Nature Medicine). Research and use is current people living with the existential challenges of a terminal illness. We explore what is known about the use of Psychedelic Assisted Therapy (PAT), indications for use and outcomes of importance in this group. Aim: To review the evidence for PAT for people facing life threatening illness. Method: We use narrative review to identify themes regarding the evidence, clinical considerations, of PAT in people facing life threatening illness.

Results We found several important studies, licencing approvals, and themes

- In July 2023, Mitchell, J.M. et al. MDMA-assisted therapy for moderate to severe PTSD: a randomized, placebo-controlled phase 3 trial. This article ranked in the 99th percentile (ranked 60th) and the 98th percentile (ranked 2nd) of articles of a similar age in Nature Medicine.

• 2024 the US Food and drug administration is reviewing the application for MDMA supported therapy for this indication with a decision expected this year.

  o Schipper S et al have recently had a systematic review and meta analysis accepted by Cochrane (2024), their findings suggest more investigation of a role for PAT of anxiety, depression and existential distress, for patients with life-threatening disease.

• The Australian Therapeutic Goods acceptance of the indications permit prescribing MDMA for the treatment of post-traumatic stress disorder (PTSD) and psilocybin for treatment-resistant depression (TRD) by psychiatrists who are specifically authorised under the TGA’s Authorised Prescriber scheme, is effective from 1 July 2023.

• Seven reviews for indications in palliative care settings are currently underway, with a total recruitment target of 720 participants.

• These emerging treatments require engagement from clinicians, consumer and advocacy groups, to understand the evidence the particular issues associated (e.g. in PAT, informed consent poses challenges) Other issues to be discussed are costs, a potential role for Palliative Care Physicians in diagnosis, referral, and palliative care multidisciplinary team members as potentially skilled co-therapists PAT.

• Critically, training for this emergent modality is pertinent.

Discussion These studies and decisions including the US FDA MDMA in PTSD and results of current studies in PAT for patients with prognoses up to 2yrs will shape our practice. Although mentioned in the successful TGA application, PAT for existential distress (unless for TRD or PTSD) in people receiving palliative care is not approved. At this stage we can say the following themes are present in the literature, efficacy and ethics in palliative care settings, ethics of consent, training accreditation and governance. Conclusion: Strategies to better understand safe integration of PAT in to care for people with life limiting illness are needed.