design research of cancer infusion treatment environments
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Design Research
of Cancer Infusion Treatment Environments
EDRA 42 | Chicago, Illinois | May 26, 2011
Zhe Wang, Ph.D., RA, EDAC, LEED AP BD+C
Michael Pukszta, AIA
Natalie R. Petzoldt, AIA, EDAC, LEED AP BD+C
Jennifer Hendrich Cayton, LEED AP BD+C
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1. Introduction
2. Cannon Design Research
3. Post Occupancy Evaluation of the Simon Cancer Center
Overview of presentation
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Americans and Cancer- 2010 Facts and Figures
Cancer | “Group of diseases characterized by uncontrolled growth and spread of
abnormal cells;” genetic or environmental
Treatment | Surgery, Radiation, Chemotherapy, Hormone, Biological, Targeted Therapies
2010 Death Rate | 569,490 expected cancer deaths alone, more than 1,500 a day
2010 Diagnoses | 1,529,560 expected new diagnoses
1. American Cancer Society, “2010 Cancer Facts and Figures.”
http://www.cancer.org/Research/CancerFactsFigures/CancerFactsFigures/cancer-facts-and-figures-2010 Accessed 05.16.2011
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Improving the patient outcomes
Americans have made measurable success in battling cancer and increased the relative
5-year survival rate from 50% in 1970s to 66% in 2009.
1. American Cancer Society, “2010 Cancer Facts and Figures.”
http://www.cancer.org/Research/CancerFactsFigures/CancerFactsFigures/cancer-facts-and-figures-2010 Accessed 05.16.2011
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The typical healthcare patient
Time
Health
event
Diagnosis
Treatment
Infusion treatment:
50+% cancer patients undergo
chemotherapy1
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The oncology patient
Time
Health
event
Diagnosis
Treatment
Potential 100 Trips
in the first year after diagnosis
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Evidence-Based Design and Research
Evidence Based Design: Evidence-based design is the process of
basing decisions about the built environment on credible research to
achieve the best possible outcomes. For healthcare, the goal is to
achieve the best possible outcomes for patients/residents, families, and
staff while improving the process of delivery. 1
1. Center for Health Design. Access 5/16/2011 . http://www.healthdesign.org/chd/research
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Evidence-Based Design and Research
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Evidence Based Research and Design- Oncology
Most research in the field of design and health focuses on
inpatient environments.
However, typical cancer treatment regimen is ambulatory-based.
1. Chemotherapy.com Access 05/19/11. http://www.chemotherapy.com/treating_with_chemo/treating_with_chemo.html
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Evidence-Based Design and Research- Oncology?
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Cannon Design
Offices | 16
People | 1000
Healthcare | Top Ranking in Healthcare Design
Quick Facts | Ph.D. lead health and science research; award winning practice
Boston
NYC
Arlington
PhoenixLos Angeles
Chicago
Buffalo
Baltimore
St. Louis
Vancouver
Toronto
San Francisco
Victoria
ShanghaiMumbai
Houston
Calgary
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Humble Beginnings- The Pre-design Research
“If we knew what we were doing, it would not be called research, would it?”
Albert Einstein
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Humble Beginnings- Pre-design Research
Location Summary
Clarian IU Simon Cancer Center (Now IU Health)
Indianapolis, Indiana
Todd Caner Center
Los Angles, California
Siteman Caner Center
St. Louis, Missouri
Karmanos Cancer Institute
Detroit, Michigan
Cancer Care of Maine
Bangor, Maine
MD Anderson Banner Health
Phoenix, Arizona
UH Case Medical Center
Cleveland, Ohio
Northwestern
Chicago, Illinois
Phase 1
Phase 2
8 States
410+ Patients
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10- Year Research Project Cycle
2007
Karmanos Cancer Center
Detroit, MI
Focus Groups
Patient Interviews & Surveys
2005
Cancer Center of Maine
Bangor, ME
Focus Groups
Patient Interviews
& Surveys
2004
Todd Cancer Center
Long Beach, CA
Focus Groups
Patient Interviews
2000 2004 2008 2010
Re
se
arc
hP
roje
cts
1999-2000
Siteman Cancer Center
St. Louis, MO
Focus Groups
Patient Interviews
2003-2005
Clarian/IU
Simon Cancer Center
Indianapolis, IN
Focus Groups
Patient Interviews
BJC / Washington University
Siteman Cancer Center
750,000 Sq Ft
IU Health
Simon Cancer Center
450,000 Sq Ft
Seidman
Cancer Hospital
450,000 Sq Ft
2007
Banner Health
Phoenix, AZ
Patient Questionnaires
Focus Group
2008
Northwestern University
Chicago, IL
Patient Questionnaires
UH Case Medical Center
Cleveland, OH
Patient Questionnaires
Focus Group
2010
IU Health
Simon Cancer Center
Indianapolis, IN
Post Occupancy Evaluation
MD Anderson
Banner Cancer Center
225,000 Sq Ft
Karmanos Cancer Institute
Weisburg Cancer Center
25,000 Sq Ft
King Abdullah
Saudi Arabia
1,500,000 Sq Ft
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From Pre-design Study to Post Occupancy Evaluations
2010 2012
Re
se
arc
hP
roje
cts
Seidman
Cancer Hospital
450,000 Sq Ft
MD Anderson
Banner Cancer Center
225,000 Sq Ft
TARGET 2012
Banner Health
Phoenix, AZ
Post Occupancy Evaluation
Seidman Cancer Center
Cleveland, OH
Post Occupancy Evaluation
Construction of Phase 2 projects is
completing or near complete in 2011
Target Post Occupancy Evaluations for
2012
Potential comparative study of three
complete projects
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Research Road Map
PHASE 2
PRE-DESIGN STUDY
PHASE 1 PILOT STUDY VERIFICATION
PHASE 2 VERIFICATION
WE ARE
HERE
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Summary of Pre-design Research Findings
Infusion patient needs can be classified into three categories:
1) Choice and control
2) Privacy and social support
3) Positive distractions
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Summary of Findings: Choice and Control
“A sense of control is important because cancer takes
away your control.”
- Patient from Todd Cancer Institute
“What control would an infusion patient want most?”
Temperature Control
Typology of treatment stations: Private or Open
1. Image Digital Thermostat. Accessed 5/17/2011 http://digitalthermostat.org/
Potential Design Solutions:
-Multiple HVAC zones
-Multiple types of treatment station
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Summary of Findings: Privacy and Social Support
Private50%
Share22%
Sometimes28%
n = 161
Private treatment rooms preferred by
50% if survey participants, remaining
split 28% always choose shared and
22% flexible depending on treatment
day.
Gender and geographic changes in preferences
affect the balance of private and shared treatment
spaces.
Potential Design Solutions:
- Multiple types of treatment spaces
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Summary of Findings: Positive Distractions
90% of participants cited a guest chair as their preferred amenity.
“It felt really good about helping a patient sitting next to me. She didn’t
speak English , but holding hands with another patients means the
same thing in any language.”
-Todd Cancer Institute Patient
“What amenity would you prefer?” Guest Chair
Potential Design Solutions:
-Plan for a guest chair at each treatment station
-Family lounge space for guests and social interactions
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Patient Needs
1 Patient Control and Choice
2 Privacy and Social Support
3 Positive Distractions
Ranking Design Strategies
1 Treatment Station Typology
2 Window View
3 Family Lounge
4 Way-finding
5 Access to patient toilets
Summary of Pre-design Research and Design
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Design of Simon Cancer Center
Development of design strategies
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Simon Cancer Center | Indianapolis, Indiana
1. Brian Drumm photo courtesy of IUPUI Communications and Marketing
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Simon Cancer Center | Indianapolis, Indiana
Located Downtown
Indianapolis, Indiana1. Google Maps. Accessed 5/18/2011. www.maps.google.com
N
28,500 Square Foot Infusion Center
60 Patient treatment stations
Treats most types of caner with exception of Bone
Marrow
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Simon Cancer Center | the Infusion Center
Open Bays for patient
and guest interaction
Roof top garden
Fireplace lounge area
Private Rooms
Nurse work station
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Most cancer centers use fabric curtains to separate open bays, Simon the team
designed movable screens between patient bays
Simon Cancer Center: Choice on Privacy or Open
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Simon Cancer Center: Fireplace Lounge Area
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Post Occupancy Evaluation of Simon Cancer Center
Investigate the significance of design strategies
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Simon Cancer Center | Indianapolis, Indiana
2010 | Post Occupancy Evaluation
Observation (2 days on site)
Questionnaires
- 165 Patients
-138 Family members
- 15 Staff
Patient responses:
Response rates 20% - 45% depending
on the day
Average age range was 51-60 years old
70% were female
85% were Caucasian
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Simon Cancer Center: Research Timeline
2009 2010 2011
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Simon Cancer Center: On-site Observation
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Simon Cancer Center: Questionnaire Survey
Participants answered surveys while in the space
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Simon Cancer Center: Findings
Typology of
treatment
stations
Access to
Patient
Toilets
Window
View
Way-
finding Distances
Privacy
Un-Stress
Comfort
Satisfaction
Hope
Significantly related, p<0.02
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Private treatment rooms
1. The Telegraph. Access 5/19/2011 http://www.telegraph.co.uk/health/healthnews/7520628/Thousands-of-NHS-patients-dying-needlessly-expert.html
2. Integrative Focus, Inc. Accessed 5/19/2011 http://intergrativefocus.com/services/small_bytes
3. Mass General Cancer Hospital Accessed 5/19/2011 http://www.massgeneral.org/cancer/about/newsarticle.aspx?id=2487
4. With Friendship.com Accessed 05/22/2011. http://withfriendship.com/user/boss/chemotherapy.php
Semi-open treatment Open treatment
Simon Cancer Center: Typology of Treatment Stations
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Simon Cancer Center: Typology of Treatment Stations
During observation, patients consistently
choose seats at end of semi-open treatment
space first
Then, they choose the seats in the middle. If
the patients were receiving chemotherapy for
the first time, nurses directed them here as
well.
The last seats chosen were always in between
other patients.
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Simon Cancer Center: Access to Patient Toilets
Patients indicated increased levels Privacy,
Stress, Satisfaction, Comfort, and Hope with
regard to access to patient toilets (p<0.01)
Infusion patients may use toilets more
frequently given long treatment sessions and
administration of fluid medications.
Design Implication: Plan appropriately
distributed patient toilets, consider
additional beyond code required.
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Simon Cancer Center: Access to Patient Toilets
Semi-open treatment stations and shared
patient toilets
Private treatment rooms and shared patient
toilets
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Simon Cancer Center: Window View
Patients with window views reported
higher levels of Privacy, Comfort,
Satisfaction, Hope and lower levels
of Stress than those without window
view
Other EBD research reports lower
use of medications and increase
healing in patient with window views
Design Implication: Site, building
orientation and department
placement with access to daylight
and view are important. Consider
planning window views for private
treatment stations
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Simon Cancer Center: Way-finding and travel distances
Good way-finding was associated with
Comfort, Satisfaction, Hope and lower levels of
Stress
Previous EBD studies note stressful way-
finding can be addressed by adjusting spatial
references
Design Implication: Distribute toilet rooms,
nourishment, and reduce travel distance
from treatment areas and waiting rooms.
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Simon Cancer Center: Lounge Space and Guest Chairs
Surprisingly, 93 of 160 survey participants said
they would not like to sit in the lounge area.
During observation it was noted the staff would
not let the patients select a chair in the lounge
area. Staff often directed first time patients
towards the middle chairs for visibility during
first treatment
Lounge space was utilized by guests for
napping and additional seating.
Design Implication: Additional places for
respite for patient companions should be
considered in planning.
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Summary of Findings: Significant Design Strategies
Design strategies
1 Treatment station typology
2 Window View
3 Family lounge
4 Way-finding
5 Access to patient toilets
Ranking by significance in POE
1 Treatment station typology
2 Access to patient toilets
3 Window View
4 Way-finding
5 Family lounge
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Conclusions
• Significant environmental features in Cancer infusion treatment
environments are similar but different from that in inpatient
environments.
• The validity and reliability of suggested design strategies need to be
examined, with respect to the unique characteristics of target patient
population.
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Questions?
Zhe Wang, Ph.D., RA, EDAC, LEED AP BD+C
Cannon Design
1100 Clark Avenue
St. Louis, Missouri 63102
Email: zwang@cannondesign.com
www.cannondesign.com
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