“The meaning of palliative care is to add life to patients’ days, not days to their lives.” 
— Dame Cicely Saunders, founder of the hospice movement 

Introduction 

This blog post was inspired by a recent Palliative Talks HPCO podcast series episode with Dr. Benoit Robert. In the interview, host Kath Murray asked Dr. Robert about his work with older adults in long-term care. 

Dr. Robert explained that in long-term care, everything comes down to relationships with residents. A key part of that relational care is taking the time to learn what matters most to each person—their values, wishes, and goals. He used frailty as an example of how investing clinical time in understanding a resident’s priorities can be both a wise use of professional time and a precious gift to the resident, enhancing the quality of their time left. 

Frailty is not a disease. Sometimes it is simply part of aging, but more often it reflects the accumulated effects of living with chronic illness, the side effects of multiple medications, and/or dementia. Dr. Robert likens frailty to a canoe that, over time, sinks lower in the water. Eventually, there’s only a small gap between the waterline and the rim. A person can live with quite advanced frailty—if the “water” stays calm, the canoe will keep floating for a long while. But the closeness to the edge means they remain vulnerable. Even small “waves” or “headwinds”—minor illnesses, injuries, or stressors—can quickly become life-altering or even life-threatening. 

When we overlook the ways frailty shapes both longevity and quality of life, Dr. Robert warns, we risk robbing people of the chance to enjoy the time they have. In his view, there is no downside to giving the gift of good time. 

Time vs. Temporality

Time can be understood in two ways. One is clock time—the hours and minutes measured by schedules and calendars. The other is temporality—a person’s lived experience of time, which can feel fast, slow, or suspended depending on what they are going through (Giuliani et al., 2015). 

Temporality becomes especially important in the context of illness and dying. Sixty years ago, many people died suddenly after an accident or infection, often at home. Today, most older adults in Canada live with multiple chronic illnesses (PHAC, 2020), and many experience a slow decline following a long period of illness, hospitalizations, or medical treatments (Hsu & Garner, 2020; Mendes, 2014). 

Because of this shift, it’s essential to bring a palliative approach to the care of people with serious or life-limiting conditions—early on, not just at the very end. When palliative care starts alongside treatments, it helps people live well with illness by focusing on what matters most to them—their goals, their values, and their experience of time. 

This blog explores how understanding a person’s sense of time—or temporality—helps providers meet people where they are — emotionally, psychologically, and existentially — which strengthens the quality and humanity of a palliative approach to care 

Living with Uncertain Time: How People Experience It 

For people living with serious illness(es), time can feel uncertain or disjointed. It is often experienced in two overlapping ways: 

• Inner time – shaped by illness: hours spent at medical appointments, waiting for test results, or recovering from treatments. 
• Outer time – shaped by others: time spent with loved ones, caregivers, and health professionals, who are present but not living the illness themselves (Toombs, 1990). 

People may experience shifts in the pace of time: 

• For some, it speeds up—especially during a flurry of tests or treatment decisions. 
• For others, it slows down. Many people describe a “waiting time” when the future feels uncertain, but the present becomes more meaningful—a chance to savor moments, give away belongings, or say goodbye (Robertson, 2015; Joshi et al., 2024). 

As death nears, people often reflect on the future in different ways: 

• Planning for a peaceful, timely death—not a prolonged one (Robertson, 2015). 
• Thinking about their legacy and imagining life for those they leave behind (Robertson, 2015; Joshi et al., 2024). 
• Finding meaning, purpose, or connection—often associated with less psychological distress at the end of life (Lee et al., 2004). 

For care providers, understanding how time is experienced by the person can help shape care that is aligned with their priorities. It can also guide short-term, meaningful goals that focus on comfort, dignity, and quality of life. 

The Dual Burden of Time for Clinicians 

Clinicians have a different but equally complex relationship with time. While people receiving care may focus on emotional, spiritual, or existential aspects of time, clinicians often work under pressure to prioritize tasks, symptoms, and outcomes (Mendes, 2014). 

A study by Vachon et al. (2020) explored how clinicians experience time in palliative care settings: 

• Many feel caught between a fast-paced, task-oriented environment and the desire to offer meaningful, presence-based care. 
• Being fully present with patients is seen as a way to honour their stories and relationships. 
• Some clinicians “borrow time” from other parts of life, such as skipping breaks or extending their work hours. 
• Others try to “pause time” by using mindfulness techniques—slowing down, being present, and creating space for meaningful interactions. 

From Time Management to Managing Temporality 

In healthcare, there is often a tension between managing time and making time meaningful. 

• Clinicians may sacrifice their own time and wellbeing to be more present with patients. 
• Patients and families may sacrifice time together in exchange for treatments that might extend life. 

A palliative approach invites a different way of thinking: time isn’t just something to measure—it’s something to live. It encourages clinicians and caregivers to listen deeply, slow down when possible, and support people in living fully—wherever they are in their illness journey. 

Reflection 

What would it change in your practice if you focused less on how much time a person has and more on how they experience that time? 

References  

1. Giuliani, L., Piredda, M., Ghilardi, G., & Marinis, M. G. D. (2015). Patients’ perception of time in palliative care: a metasynthesis of qualitative studies. Journal of Hospice & Palliative Nursing, 17(5), 413-426. 
2. Hsu, A. T., & Garner, R. E. (2020). Associations between the receipt of inpatient palliative care and acute care outcomes: A retrospective study. Health Reports, 31(10), 3–14. https://doi.org/10.25318/82-003-x202001000001-eng 
3. Joshi, M., Ásgeirsdóttir, G. H., Bakan, M., Kodba Čeh, H., Haugen, D. R. F., Lunder, U., … & iLIVE Consortium. (2025). Dealing with temporality in patients with life-limiting disease: An international qualitative study. Qualitative Health Research, 35(3), 335-348. . 
4. Lee, V., Cohen, S. R., Edgar, L., Laizner, A. M., & Gagnon, A. J. (2004). Clarifying “meaning” in the context of cancer research: A systematic literature review. Palliative & Supportive Care, 2(3), 291-303.. 
5. Mendes, A. A. A. (2014). The time that remains: Self-identity and temporality in cancer and other life-threatening illnesses and in Messianic experience. Palliative & Supportive Care, 12(2), 165-168. 
6. Robertson, M. (2015). Experiences of time: A qualitative inquiry into experiences of time as described by palliative care inpatients. Palliative & Supportive Care, 13(1), 67-73. 
7. Public Health Agency of Canada. (2020, November 12). Prevalence of chronic diseases and risk factors among Canadians aged 65 years and older (Catalogue No. HP35141/2020EPDF). Government of Canada. https://doi.org/10.25318/9780660360188 
8. Toombs, S. K. (1990). The temporality of illness: Four levels of experience. Theoretical medicine, 11(3), 227-241.  
9. Vachon, M., Goyette, C., & Guité-Verret, A. (2020). Presence and the paradox of time for palliative care clinicians: A phenomenological study. The International Journal of Whole Person Care, 7(2), 13-25. 

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