Date of Award

January 2021

Document Type


Degree Name

Medical Doctor (MD)



First Advisor

Benjamin Kelmendi

Second Advisor

Mark Lazenby


Existential distress is a significant source of suffering for patients facing life-threatening or life-limiting illness. Psychedelic-Assisted Therapy (PAT) is a novel treatment that has shown promise in treating existential distress, but openness to PAT may be limited by the paucity of educational material for the use of psychedelics in medicine and stigma against psychedelics due to their status as Schedule I substances. The present study aims to elucidate attitudes of palliative care clinicians toward current treatments for existential distress and potential of PAT as a treatment for existential distress. We recruited palliative care physicians, advanced practice nurses, chaplains, and mental health specialists from multiple US sites using purposive and snowball sampling methods. Semi-structured interviews targeted at attitudes toward existential distress and PAT were transcribed and analyzed for thematic content according to grounded theory. 19 respondents (7 physicians, 4 advanced practice nurses, 4 chaplains, and 4 social workers/psychologists) were interviewed. Four core themes were identified: 1) Existential distress is a common experience that is frequently insufficiently treated within the current treatment framework; 2) Palliative care, ultimately, sees existential distress as a psychosocial-spiritual problem that evades medicalized approaches; 3) Palliative providers believe PAT holds promise for treating existential distress but that a stronger evidence base is needed; 4) Because PAT does not currently fit existing models of existential distress treatment, barriers remain. Palliative care providers acknowledged gaps in treatment of existential distress among patients with life-threatening and life-limiting illness, and are supportive of efforts to expand research of PAT in this population. Further work to adapt PAT to the palliative care setting, including greater collaboration with spiritual care providers, is needed to ensure broad and equitable access to this novel treatment.


This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.