Background: A recently published randomized controlled trial compared single-dose psilocybin with single-dose niacin in conjunction with psychotherapy in participants with cancer-related psychiatric distress. Results suggested that psilocybin-assisted psychotherapy facilitated improvements in psychiatric and existential distress, quality of life, and spiritual well-being up to seven weeks prior to the crossover. At the 6.5-month follow-up, after the crossover, 60–80% of participants continued to meet criteria for clinically significant antidepressant or anxiolytic responses. Methods: The present study is a long-term within-subjects follow-up analysis of self-reported symptomatology involving a subset of participants that completed the parent trial. All 16 participants who were still alive were contacted, and 15 participants agreed to participate at an average of 3.2 and 4.5 years following psilocybin administration. Results: Reductions in anxiety, depression, hopelessness, demoralization, and death anxiety were sustained at the first and second follow-ups. Within-group effect sizes were large. At the second (4.5 year) follow-up approximately 60–80% of participants met criteria for clinically significant antidepressant or anxiolytic responses. Participants overwhelmingly (71–100%) attributed positive life changes to the psilocybin-assisted therapy experience and rated it among the most personally meaningful and spiritually significant experiences of their lives. Conclusion: These findings suggest that psilocybin-assisted psychotherapy holds promise in promoting long-term relief from cancer-related psychiatric distress. Limited conclusions, however, can be drawn regarding the efficacy of this therapy due to the crossover design of the parent study. Nonetheless, the present study adds to the emerging literature base suggesting that psilocybin-facilitated therapy may enhance the psychological, emotional, and spiritual well-being of patients with life-threatening cancer.

pproximately 11.3 million undocumented immigrants live and work in the United States. 1 Because this lowincome population is excluded from a range of public benefits that include Medicare, federally funded Medicaid, and the insurance provisions of the Affordable Care Act, undocumented immigrants are a significant portion of the post-Affordable Care Act population who remain uninsured. 2 Their access to health care is limited largely to safety-net provisions for the uninsured, chiefly, nonprofit community health centers, public clinics, and emergency treatment in hospital emergency departments (EDs) mandated by the 1986 Emergency Medical Treatment and Active Labor Act (EMTALA). 2,3 Arranging care is especially complex when an undocumented immigrant is diagnosed with end-stage renal disease (ESRD), for which hemodialysis is a life-sustaining treatment. 4,5 Undocumented immigrants' ineligibility for public benefits means they cannot access the diagnostically based Medicare entitlement for hemodialysis. 6 An estimated 6480 undocumented immigrants in the United States have ESRD. 7 Their access to hemodialysis depends on state policy and local safetynet investments. Some states, including California and New York, use state emergency Medicaid programs to finance scheduled hemodialysis for these patients. 8,9 Most states, including some with large undocumented immigrant populations, IMPORTANCE The exclusion of undocumented immigrants from Medicare coverage for hemodialysis based on a diagnosis of end-stage renal disease (ESRD) requires physicians in some states to manage chronic illness in this population using emergent-only hemodialysis. Emergent-only dialysis is expensive and burdensome for patients.OBJECTIVE To understand the illness experience of undocumented immigrants with ESRD who lack access to scheduled hemodialysis. DESIGN, SETTING, AND PARTICIPANTSA qualitative, semistructured, interview study was conducted in a Colorado safety-net hospital from July 1 to December 31, 2015, with 20 undocumented immigrants (hereinafter referred to as undocumented patients) with ESRD and no access to scheduled hemodialysis. Demographic information was collected from the participants' medical records. The interviews were audiorecorded, translated, and then transcribed verbatim. The interviews were analyzed using inductive qualitative theme analysis by 4 research team members from March 1 to June 30, 2016. MAIN OUTCOMES AND MEASURES Themes and subthemes from semistructured interviews.RESULTS All 20 undocumented patients included in the study (10 men and 10 women; mean [SD] age, 51.4 [13.8] years) had been in the United States for at least 5 years preceding their diagnosis with ESRD. They described the following 4 main themes: (1) a distressing symptom burden and unpredictable access to emergent-only hemodialysis, (2) death anxiety associated with weekly episodes of life-threatening illness, (3) family and social consequences of accommodating emergent-only hemodialysis, and (4) perceptions of the health care system.CONCLUSIONS AND ...

Context Latinos experience significant health disparities at the end of life compared with non-Latinos. Objectives To determine the feasibility of a patient navigator intervention to improve palliative care outcomes for Latino adults with serious illness. Methods This was a pilot randomized controlled trial that included 64 Latino adults with life-limiting illness randomized to an intervention or control group. All participants received a packet of linguistically matched materials on palliative care. In addition, intervention participants received up to five home visits from the bilingual, bicultural patient navigator. Visits focused on addressing barriers to palliative care through education, activation, and culturally tailored messaging. Outcomes included feasibility and advance care planning rates, documentation of pain management discussions in the medical record, and hospice utilization. Results Of the 32 patients randomized to the intervention arm, 81% had at least one home visit (range 1–5) with the patient navigator. Overall, advance care planning was higher in the intervention group – 47% (n = 15) vs. 25% (n = 8) (P=0.06), and 79% of intervention participants had a discussion about pain management documented in their medical record vs. 54% of control patients (P = 0.05). Hospice enrollment between the two groups (n=18 decedents) was similar (n=7 intervention vs. n=6 control; length of stay in the intervention group was 36.4± 51.6 days vs. 19.7±33.6 days for control patients (P = 0.39). Conclusion A culturally tailored patient navigator intervention was feasible and suggests improved palliative care outcomes for Latinos facing advanced medical illness, justifying a fully powered randomized controlled trial.

Palliative care is often offered only late in the course of disease after curative measures have been exhausted. To provide timelier symptom management, advance care planning, and spiritual support, we propose a simple set of prognostic criteria that identifies persons near the end of life. In this retrospective cohort study of five prognostic indicators, the CARING criteria (Cancer, Admissions > or = 2, Residence in a nursing home, Intensive care unit admit with multiorgan failure, > or = 2 Noncancer hospice Guidelines), logistic regression modeling demonstrated high sensitivity and specificity for mortality at 1 year (c statistic > 0.8). A simple set of clinically relevant criteria applied at the time of hospital admission can identify seriously ill persons who have a high likelihood of death in 1 year and, therefore, may benefit the most from incorporating palliative measures into the plan of care.

Our classroom intervention had no significant effect on residents' attitudes towards or knowledge of end-of-life care. The fact that prior palliative care experience affects baseline scores provides a strong argument for continued research for an effective curriculum for end-of-life education, perhaps focusing on clinical rather than didactic experiences in palliative care.