Few topics in medicine spark as much uncertainty — and as much hope — as palliative care.
Often misunderstood as solely support at end of life, palliative care is actually a patient-and-family-centered practice designed to improve quality of life from the moment a serious diagnosis is made.
Dr. Breffni Hannon, Head of Palliative Care at UHN's Princess Margaret Cancer Centre, demystifies the practice. Whether a patient is newly diagnosed, living with advanced illness, or a caregiver seeking resources and reassurance, she clarifies when and how palliative care can make the greatest difference.
What is the goal of palliative care?
Our main goal with palliative care is to help patients live as well as they can for as long as they can. So, our focus is on their quality of life rather than just on the underlying illness.
We look at patients as a whole person and our goal is to help them feel well physically, emotionally and psychologically. While patients still get great care for their cancer or their underlying medical diagnosis in the absence of palliative care, we add a much-needed extra dimension. Unfortunately, many clinics and services are not set up to support the physical, emotional and mental well-being of our patients, to take care of their families, or to have difficult conversations about the care they might need in the event of their health declining in the future.
Ultimately, we aim to make sure patients feel heard, supported and empowered — while also helping families have those difficult, but necessary, conversations with clarity and compassion.
What are the biggest misconceptions patients or their families have about palliative care?
The one we hear most often is that people think it's really just relevant or appropriate at the end of life, and they don't understand that it might be helpful for them earlier in their cancer journey or their illness journey in general. That is the biggest misconception and barrier we have to overcome to engage earlier with patients and their families.
When is the best time to access palliative care?
The best time to access palliative care is early in the course of an advanced illness. As palliative care clinicians, we have a unique set of skills that can proactively help patients, their families and their caregivers cope better with their illness, manage their symptoms better and feel prepared for the future. We also have close connections with community services like Ontario Health atHome and home visiting palliative care programs. We act as a bridge between the hospital and the community for many patients and their families.
Our goal is always to help patients live as well as they can for as long as they can, no matter where they are in their illness journey, be it at the very beginning, right through to the very end.
Can you elaborate on the spiritual care aspect of palliative care? What exactly do spiritual care colleagues do for palliative patients?
A diagnosis of cancer or any other serious illness is shocking for patients and their families. People often ask themselves: Why did this happen to me? Could I have done something differently? And, some of those questions we can answer scientifically, but some are more existential or spiritual.
Part our job as palliative care nurses and doctors is to help patients navigate that uncertainty and distress around their diagnosis. Our spiritual care colleagues play a really important role in helping patients understand this uncertainty, to hold space with those questions and to really help them to prepare for the future.
What is the biggest challenge for end-stage cancer patients and their families?
One of the biggest challenges for patients with advanced cancer and their families is navigating a complex health care system while facing emotionally difficult decisions. Patients and families often struggle with managing symptoms, accessing care in the community and finding resources like caregiver support or respite services.
Communication is another major hurdle. Many patients receive care from multiple providers across different hospitals and settings, and it can feel overwhelming without a clear point person to coordinate everything. That's where palliative care teams often step in — we help connect the dots, manage symptoms, and guide patients and families through their options.
Advance care planning is also challenging. With new treatments and clinical trials constantly emerging, conversations about future care — especially beyond treatment — can be delayed. These discussions are essential but often tough to start. Our role includes helping patients and families talk through their values and goals, ensuring they have all the information they need to make informed decisions about their care and where they want to be at the end of life.
What inspired you to work in palliative care?
I've always been more interested in people than just the medical side of things. In medical school, I noticed that many specialties focus on one part of the body, but I was drawn to something more holistic. Luckily, I trained at a university where palliative care was a key part of the curriculum, so I was exposed to it early on — and I loved it.
What really stood out to me was how palliative care looks at the whole person: not just their physical symptoms, but also their emotional, spiritual and social needs, and how it includes the family in care. That approach just made sense to me. It felt like what healthcare should really be.
What advice would you give to someone interested in palliative care?
Go for it — it's an incredible field. Palliative care is built on teamwork, compassion and truly patient-centered care. A lot of people assume it's a sad or depressing specialty because it deals with end-of-life care, but honestly, it's the opposite. It's deeply rewarding to help people feel better, support families and be there during some of life's hardest moments. I feel lucky every day to do this work with such an amazing team.
What is unique about the Princess Margaret's palliative program that sets it apart from other palliative programs?
Our outpatient palliative care program is among the largest in the world and that allows us to really engage with patients and their families early in their illness course and to follow them longitudinally, which is very unique and special.
The second thing is our research and clinical trials program, which allows us to test out new ways of delivering palliative through symptom screening or virtual care, figuring out how to help more patients access palliative care earlier or how we can overcome some of the traditional barriers to palliative care. Whether those things are related to stigma or geography, we're able to change how and when we can see patients and then share our work through publications.
Of course, when you publish your research, it inspires other people to do similar work and to improve palliative care for everybody, not just here in Toronto, but around the world. And that's a really unique aspect of our program at the Princess Margaret that sets us apart.
