By: Fabian Mayer
Cancer cares little about geography. And in Alberta, a province that is bigger than many countries, geography presents an immense challenge. But advances in technology and creative approaches to delivering care are helping solve that puzzle and improving cancer care and quality of life for patients across Alberta. One such initiative is taking place at the Lloydminster Community Cancer Centre, where a virtual care approach is saving patients time, money and stress as they go through their cancer journey.
Tristin Hamilton is an oncology nurse practitioner at the Cross Cancer Institute in Edmonton. She helped implement the centre’s virtual care model and serves as the primary contact for cancer patients in Lloydminster and the surrounding region, which includes the communities of Camrose, Bonnyville, Vermillion, Wainwright and many more in between.
Hamilton says the virtual care model, the first of its kind in Alberta, grew out of a need for a cancer care provider at the Lloydminster Community Cancer Centre. With the centre lacking a permanent oncologist, patients in the region would often have to travel to Edmonton even for relatively minor appointments. Hamilton, having recently completed her master of nursing, was tasked with investigating whether using video calls and a virtual care model could improve the situation.
“It’s an ongoing issue where a lot of our rural outreach clinics do not have regular provider coverage, especially when it comes to oncology as a specialization,” says Hamilton. “The doctors are mostly in family practice, so the oncology piece is missing in a lot of cases.”
Starting in December 2020, it took Hamilton an entire year to set up the new model, making sure it would provide the same level of cancer care available in the big cities. That meant working together with nurses on the ground in Lloydminster and building relationships with service providers throughout rural Alberta to explore how virtual care could enhance patient care and quality of life. The system has been fully operational since December 2021.
“I’m overseeing their treatment through Lloydminster. It’s very much a team approach: I oversee their care in between visits with their oncologists,” says Hamilton, adding that patients come to the Cross for initial assessments and chemotherapy treatment, and followups and referrals are handled virtually by Hamilton. “Anything urgent that comes up, they contact me. With it being virtual care, there’s a quicker response if there’s an urgent issue, rather than trying to track down each individual oncologist.”
Hamilton says patients appreciate the creative approach to delivering care. There are some obvious benefits, such as cutting down on travel time and the cost of transportation. But it has also made it easier for rural patients to access different services and receive more holistic cancer care, including everything from mental health support to nutritionists and physiotherapists.
“The biggest benefit is that it’s equitable access to care for rural populations. There are a lot of services that people in rural communities just don’t access because it takes too long, whether that’s referrals or even just the driving time to get to places,” says Hamilton. “With this model, they can get on with their lives. It’s not such a disruption in their day-to-day, which is the goal. We want to keep their quality of life high.”
The key to the puzzle is improving convenience and quality of life for patients, without sacrificing the quality of care they receive. The use of video conferencing technology is invaluable, says Hamilton. It helps build a more personal rapport compared to a regular phone call, allowing Hamilton to see how her patients are doing.
“I can assess them. I can see the whites of their eyes, I can see the colour of their skin and see how they’re walking, so that really helps me with their care.”
Hamilton herself is very familiar with how technology can help navigate time constraints. She took her master of nursing remotely through Athabasca University while continuing to work as an emergency nurse at three hospitals: Sherwood Park’s Strathcona Community Hospital, the Fort Saskatchewan Community Hospital and Northeast Community Health Centre in Edmonton.
“It helped me be able to work full-time while being in school because it meant I didn’t have to sit in a classroom,” says Hamilton. “With remote learning, and even virtual care now, it’s definitely more self-directed and it’s a constant learning process. It’s okay not to know everything. You just have to know where to go to ask questions and get that support.”
Hamilton’s passion for health care came from an altogether different source. While studying political science as an undergrad, she joined the military and became a medic in the Canadian Army Reserves.
“I loved being a medic, being a grunt in the military and dealing with whatever came at you. It just sort of evolved from that,” says Hamilton. She worked in post-operative cardiac surgery and emergency medicine after earning her nursing degree before switching to oncology after graduating with her master’s degree. “I very much enjoy the acute, urgent aspects of medicine. I now find that in oncology, because anything can truly happen in oncology.”
Though she was never deployed overseas, Hamilton worked as a medic during field operations all over Canada and says that some of the lessons from her time in the military have helped her succeed in her current role.
“Virtual care is not a one-person show. You have to empower your whole team to make it work. And you can’t be on a pedestal — you have to be reachable and approachable,” says Hamilton. “Cancer care has really changed for the better for a lot of people in rural Alberta and I’m proud of what we are able to accomplish for our patients.”
As for the future of virtual care in Alberta, Hamilton thinks a hybrid model with some in-person visits and some virtual care is the way forward. If done right, she thinks it can help deal with the shortage of specialists in rural communities across the province.
“The Llyoyminister clinic has shown its ability to provide a sustainable solution for a lack of rural providers and specialists specifically,” says Hamilton. “It takes thinking outside of the box and adjusting your traditional view of how patient care is delivered, but it is entirely doable.”
Tristin Hamilton’s career highlights
2007 to 2012: Works as a medic with the Canadian Armed Forces with 11 Field Ambulance in Victoria, B.C.
June 2012: Graduates from University of Victoria with a bachelor of science in nursing and begins working in post-operative cardiac surgery at Edmonton’s Mazankowski Alberta Heart Institute.
August 2015: Is hired at the Strathcona Community Hospital as an emergency department registered nurse.
December 2019: Graduates from Athabasca University with a masters of nursing — nurse practitioner.
March 2020: Is hired at the Cross Cancer Institute as an oncology nurse practitioner.
December 2020: Initiates the nurse practitioner-led virtual community cancer clinic in Lloydminster, the first clinic under this model in Alberta.
October 2021: Panellist at the International Foundation of Integrated Care Conference.