Design Research of Cancer Infusion Treatment Environments

EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE


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

EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCEEXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE

1. Introduction

2. Cannon Design Research

3. Post Occupancy Evaluation of the Simon Cancer Center

Overview of presentation


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


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


The typical healthcare patient

Time

Health

event

Diagnosis

Treatment

Infusion treatment:

50+% cancer patients undergo

chemotherapy1


The oncology patient

Time

Health

event

Diagnosis

Treatment

Potential 100 Trips

in the first year after diagnosis


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

http://www.healthdesign.org/

http://livinghealthy.typepad.com/photos/uncategorized/2007/09/04/pebbleblog.jpg

http://www.herdjournal.com/ME2/dirmod.asp?sid=&nm=&type=Publishing&mod=Publications::Article&mid=8F3A7027421841978F18BE895F87F791&tier=2&did=FC3BA5CAD9964422ACA3C5514689922E&dtxt=Winter 2009


Evidence-Based Design and Research


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


Evidence-Based Design and Research- Oncology?


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


Humble Beginnings- The Pre-design Research

“If we knew what we were doing, it would not be called research, would it?”

Albert Einstein


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


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


UH Case Medical Center

Cleveland, OH


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


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


Seidman Cancer Center

Cleveland, OH


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


Research Road Map

PHASE 2

PRE-DESIGN STUDY

PHASE 1 PILOT STUDY VERIFICATION

PHASE 2 VERIFICATION

WE ARE

HERE


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


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


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.


- Multiple types of treatment spaces


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


-Plan for a guest chair at each treatment station

-Family lounge space for guests and social interactions


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


Design of Simon Cancer Center

Development of design strategies


Simon Cancer Center | Indianapolis, Indiana

1. Brian Drumm photo courtesy of IUPUI Communications and Marketing



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


Simon Cancer Center | the Infusion Center

Open Bays for patient

and guest interaction

Roof top garden

Fireplace lounge area

Private Rooms

Nurse work station


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


Simon Cancer Center: Fireplace Lounge Area


Post Occupancy Evaluation of Simon Cancer Center

Investigate the significance of design strategies



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


Simon Cancer Center: Research Timeline

2009 2010 2011


Simon Cancer Center: On-site Observation


Simon Cancer Center: Questionnaire Survey

Participants answered surveys while in the space


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


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

http://intergrativefocus.com/services/small_bytes

http://www.massgeneral.org/cancer/about/newsarticle.aspx?id=2487


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.


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.


Simon Cancer Center: Access to Patient Toilets

Semi-open treatment stations and shared

patient toilets

Private treatment rooms and shared patient

toilets


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


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.


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.


Summary of Findings: Significant Design Strategies

Design strategies

1 Treatment station typology

2 Window View

3 Family lounge

4 Way-finding


Ranking by significance in POE

1 Treatment station typology


3 Window View

4 Way-finding

5 Family lounge


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.


Questions?

Zhe Wang, Ph.D., RA, EDAC, LEED AP BD+C

Cannon Design

1100 Clark Avenue

St. Louis, Missouri 63102

Email: [email protected]

www.cannondesign.com

http://www.cannondesign.com/


Health & Medicine

Design Research of Cancer Infusion Treatment Environments