With over 100 investigators, healthcare providers, trainees, community and policy stakeholders, and patient and family partner members, the Pan-Canadian Palliative Care Research Collaborative is a network of practice-focused research groups aiming to produce high-quality palliative care research.
Our members have a passion for research and are looking to be actively involved in a palliative care research network. They come from many disciplines and include patients, caregivers, trainees, policy makers, clinicians, and researchers.
Dr. Kate Nelson is a clinician scientist in pediatric palliative care at The Hospital for Sick Children’s (SickKids) Research Institute. She is also an Assistant Professor of Pediatrics at the University of Toronto. Her work centers on an extremely difficult reality in healthcare: how families make decisions for children with serious illness when there is little or no evidence to guide them. She wants to understand how families and clinical teams make decisions, navigating uncertainty, emotion, and conflict in the process.
At the heart of Dr. Nelson’s work is a commitment to supporting families facing what she describes as “impossible decisions.” In pediatric palliative care, randomized controlled trials (RCTs) are rare. Families are often asked to choose between options without clear predictions of outcomes, while clinicians may feel uneasy making recommendations not grounded in conventional evidence. Dr. Nelson is motivated by this tension and by the weight it places on families.
The first area of her research program focuses on using Ontario health data to address specific decision points where evidence is lacking. Rather than organizing her work around particular diagnoses or scenarios, Dr. Nelson looks for moments in care that are especially challenging for families and asks how population-level data might help inform those choices. The second arm of her research tackles situations where evidence may never exist due to the rarity or complexity of children’s conditions. In these contexts, she explores how decision-making processes can be structured to better support families, particularly through approaches that prioritize family values.
Dr. Nelson is especially interested in how shared decision-making functions in pediatrics, where the traditional model—clinicians presenting evidence-based recommendations—often falls apart. In the absence of definitive clinical data, palliative care has to “do things differently,” she says. “We really think about matching and making recommendations based on a family’s values.” Her work seeks to understand how clinicians can help families feel supported rather than responsible for outcomes that no one can reliably foresee.
Another major focus of her research is conflict in clinical decision-making. Dr. Nelson has seen firsthand how differences in interpretation, emotional responses, and perceptions of authority can lead to conflict between families and care teams—or within teams themselves. These conflicts can be a major source of moral distress and burnout for clinicians and can deeply affect families’ experiences of care. Upon being awarded funding in the PCPCRC’s Seed Funding Competition in 2024, Dr. Nelson launched a scoping review looking at interventions designed to address conflict in healthcare settings. This project maps how conflict is defined, which types of conflict are targeted, and what strategies are used to manage it, laying the groundwork for future intervention-focused research.
Dr. Nelson joined the PCPCRC Executive as Pediatric co-Lead, alongside Dr. Leonie Herx, and has since found a strong and welcoming network. She is eager to help build a more visible pediatric palliative care community within the PCPCRC and to contribute to a national home for Canadian pediatric palliative care research. What has stood out most to her is the generosity of the PCPCRC community. “Every person I’ve reached out to has responded more generously than I could have imagined,” she says. “It’s been great to see how that pay-it-forward attitude shifts the entire sense of us all being in this together. We’re all working in different ways, but have the same goals in mind: to support each other and to do right by our patients and families in Canada.”