Advancing the evidence-based for hypnotherapy in palliative care: A call for pragmatic clinical integration

Dear Editor,

I enjoyed reading the work of Vayne-Bossert and Hardy, ¹ “Is there a role for hypnosis in palliative care?” that has been published in Palliative Care and Social Practice. Their narrative review neatly canvasses a neglected area of integrative medicine in palliative care. As a practitioner-researcher in supportive care, I congratulate the authors for exploring the possibilities of hypnotherapy in symptom management and patient self-efficacy. However, this is something I will build on, to identify a few significant implications and a way out of it for clinical integration.

First, the review correctly highlights the lack of high-quality evidence for hypnosis in advanced disease settings. But this should not be a barrier to considered clinical uptake. That the goals of care in palliative care frequently change from a curative strategy to symptom management to psychosocial well-being suggests that interventions do not always require the same thresholds of evidence as in curative approaches. ² Hypnosis—low risk, high patient satisfaction—should be used as a pragmatic treatment in an ethically supervised manner, in particular for analgesia, anxiety, and procedural distress.^3,4

Second, because hypnosis is individualized and experiential, it is sometimes seen as a methodological challenge in research. Instead of trying to fit the treatment of hypnosis to a set of standardized best practices, future research should consider the use of a realist evaluation approach, or pragmatic trial methodology that better accounts for, the contexts in which treatment is applied. ⁵ These methods would enable investigation of how, for whom, and in what contexts hypnotherapy provides benefit in palliative settings—questions of greater clinical significance than those addressed by average treatment effects.

Third, the authors consider that cancer patients are often treated with hypnosis, but other patients receiving palliative care for severe progressive disease (e.g., end-stage heart failure, neurodegenerative disease, chronic respiratory failure) are not. Such individuals often endure undertreated symptoms including dyspnea, insomnia, existential distress, and total pain-symptom themes which may be especially amenable to hypnotic approaches. Modified hypnotherapeutic scripts, integrating meaning-making, sensory reframing, or breath-focused imagery, may be trialled in these groups.

Moreover, I suggest that the profession begin to offer courses of study in clinical hypnosis for those who specialize in palliative care, similar to certificate courses in narrative medicine or mindfulness-based stress reduction. This would facilitate ethical delivery and further interdisciplinary cooperation among psycho-oncology, spiritual care, and behavioral medicine practitioners. Training might focus on building rapport, assessing suggestibility, and trauma-informed trance work.

Finally, I agree with the authors that more stringent trials are needed. Nevertheless, we also need qualitative research reflecting the experiences of patients, what they see as the benefits, and what they see as barriers to hypnosis. Combining both quantitative and narrative results should enhance the ability to inform patient-centered care. ⁶

In conclusion, hypnosis should not be an outer edge of the therapeutic circle, or be limited to only highly motivated breast cancer patients. It needs to be investigated as an adjunctive, evidence-based, and compassionate instrument in the palliative care armamentarium of the clinician. ⁷ That’s why now is the time to bust some myths, to develop skills and to integrate hypnotherapy into person-centered, comprehensive palliative care models, centered on patient autonomy, dignity, and comfort.

Dominikus David Biondi Situmorang Department of Guidance and Counseling, Atma Jaya Catholic University of Indonesia, DKI Jakarta, Indonesia