Photo caption: Members of the PEGASUS team at St. Joseph's Healthcare Hamilton. (Left to right) Dr. Madelaine Verhovsek, chief of medicine; Kathleen Willison, RN; Kaitlyn Boese; Dr. Britta Berg; Dr. Anne Boyle; Dr. Mino Mitri, head of service; Alisa Walzak, RN; Dr. Merna Wassef and Dr. Katalin Ivanyi, chief of family medicine. Not pictured: Dr. Alexandra Farag and Jane Loncke, senior director post-acute care, community partnerships and palliative care.
At first glance, PEGASUS might sound like something out of mythology. But at St. Joseph's Healthcare Hamilton, it’s very real — and it’s taking palliative medicine to new heights.
Launched earlier this year, the PEGASUS program, short for palliative expertise group for ambulatory support and unified solutions, is an innovative, mobile model of care that brings palliative medicine directly to patients in outpatient clinics across the hospital. Rather than establishing a traditional clinic space, the PEGASUS team “flies” to where the need is.
“Most people think of a clinic as a fixed space — you refer a patient and they show up where the clinic is,” says Dr. Mino Mitri, head of service for palliative medicine and one of the program’s co-creators. “But PEGASUS turns that model inside out. Our entire service is built on the concept that we go to them.”
The idea for PEGASUS emerged organically, built from years of conversations and growing requests from hospital specialists, especially in nephrology and respirology, who saw firsthand the unmet needs of their patients living with chronic, life-limiting conditions.
“These weren’t one-off requests,” says Dr. Mitri. “There was a real appetite for something structured, something sustainable.”
Together with Jane Loncke, clinical program director for post-acute care, community partnerships, and palliative medicine, the pair restructured the hospital’s existing inpatient palliative services to make space, figuratively and literally, for this new outpatient initiative.
The result: a consultation-based team that integrates seamlessly into existing ambulatory clinics, avoiding duplication of services and focusing on enhancing continuity of care.
More Than End-of-Life Care
Despite common misconceptions, palliative care isn’t just about end-of-life planning. It’s about helping patients clarify their goals of care early in their journey and aligning medical treatment with what matters most to them.
“Palliative medicine can offer so much more than people realize,” says Dr. Mitri. “We’re helping patients manage symptoms, make informed decisions, and plan ahead not just in the final days or weeks, but often months or even years before that.”
Dr. Mitri recounts a recent PEGASUS visit to the Firestone Institute for Respiratory Health, where he met a man with advanced chronic obstructive pulmonary disease (COPD). Each consultation starts with the same task: getting to know the patient as a person. PEGASUS then helps patients understand that palliative care focuses on symptom management and proactive care planning to enhance their overall quality of life, aligning care plans with what matters most to the patient.
“We documented his care wishes clearly,” says Dr. Mitri. “It had a meaningful impact on both his safety and his peace of mind.”
While it’s still in its pilot phase, the PEGASUS team sees one to two patients a week on average and the feedback has been overwhelmingly positive. “The introduction of the PEGASUS program has provided a much-needed opportunity to connect these patients to a team focused on managing symptoms and improving quality of life,” says respirologist Dr. Joshua Wald. “My patients with advanced lung disease often struggle with symptoms such as cough, and breathlessness despite treatment for their disease. Chronic severe breathlessness often causes anxiety and leads to isolation for people who have difficulty leaving their homes due to symptoms.”
“This isn’t a side project or a passion project that disappears when someone leaves,” notes Dr. Mitri. “PEGASUS is its own service, with its own identity. That gives it staying power.”
Loncke agrees, emphasizing the collaborative nature of its success: “We didn’t start by saying, ‘We want to create a program.’ It started with others — physicians, patients — saying, ‘We need something.’ And then asking, ‘How might we?’”
In a health care system often constrained by limited space and tight budgets, that kind of ingenuity is essential. PEGASUS operates without its own clinic space, waiting room, or dedicated infrastructure. Instead, it leverages what already exists — clinic rooms, EMR systems, people — to create something entirely new.
Future Fllight Paths
Still in its infancy, the team has ambitious plans. Dr. Mitri hopes to see PEGASUS extend into every outpatient clinic at St. Joe’s and even to sister sites across Hamilton.
“We’ve already created a pathway for patients who don’t have a family doctor,” he adds. “If we see someone through PEGASUS who’s unattached, we can connect them with a physician who can continue their care. That’s powerful.”
But more than expansion, the team hopes PEGASUS shifts how palliative medicine is perceived.
“Palliative care isn’t about giving up,” Dr. Mitri says. “It’s about living well — on your terms, with dignity, and with the right supports. PEGASUS helps make that possible.”