Design Research of Cancer Infusion Treatment Environments
5 likes1,981 views
This document provides an overview of a presentation on designing cancer infusion treatment environments. It discusses Cannon Design's 10-year research project involving multiple cancer centers across the US and over 410 patients. The research included focus groups, interviews, questionnaires, and a post-occupancy evaluation to understand the patient experience and inform evidence-based design of cancer centers. The presentation covers Cannon Design's research findings and the typical healthcare and oncology patient experience.
Design Research of Cancer Infusion Treatment Environments
- 1. EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE
- 2. 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 PERFORMANCE
- 3. Overview of presentation 1. Introduction 2. Cannon Design Research 3. Post Occupancy Evaluation of the Simon Cancer Center EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE
- 4. 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 EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE
- 5. 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 EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE
- 6. The typical healthcare patient event Diagnosis Health Treatment Infusion treatment: 50+% cancer patients undergo chemotherapy1 Time EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE
- 7. The oncology patient event Diagnosis Health Treatment Potential 100 Trips in the first year after diagnosis Time EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE
- 8. 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 EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE
- 9. Evidence-Based Design and Research EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE
- 10. 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 EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE
- 11. Evidence-Based Design and Research- Oncology? EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE
- 12. Cannon Design Offices | 16 People | 1000 Healthcare | Top Ranking in Healthcare Design Quick Facts | Ph.D. lead health and science research; award winning practice Vancouver Calgary Victoria Toronto Boston Buffalo NYC Chicago Baltimore San Francisco Arlington St. Louis Los Angeles Phoenix Shanghai Mumbai Houston EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE
- 13. Humble Beginnings- The Pre-design Research “If we knew what we were doing, it would not be called research, would it?” Albert Einstein EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE
- 14. Humble Beginnings- Pre-design Research Location Summary Clarian IU Simon Cancer Center (Now IU Health) Indianapolis, Indiana 8 States Todd Caner Center Los Angles, California 410+ Patients 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 Phase 1 Chicago, Illinois Phase 2 EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE
- 15. 10- Year Research Project Cycle 2008 Northwestern University 2003-2005 Chicago, IL 2004 2007 Clarian/IU Patient Questionnaires Todd Cancer Center Karmanos Cancer Center Simon Cancer Center Long Beach, CA Detroit, MI Indianapolis, IN UH Case Medical Center Focus Groups Focus Groups Focus Groups Cleveland, OH Patient Interviews Patient Interviews & Surveys Patient Interviews Patient Questionnaires 1999-2000 2005 Focus Group 2007 Siteman Cancer Center Cancer Center of Maine 2010 Research Banner Health St. Louis, MO Bangor, ME IU Health Phoenix, AZ Focus Groups Focus Groups Simon Cancer Center Patient Questionnaires Patient Interviews Patient Interviews Indianapolis, IN Focus Group & Surveys Post Occupancy Evaluation 2000 2004 2008 2010 Projects Karmanos Cancer Institute BJC / Washington University IU Health Seidman King Abdullah MD Anderson Weisburg Cancer Center Siteman Cancer Center Simon Cancer Center Cancer Hospital Saudi Arabia Banner Cancer Center 25,000 Sq Ft 750,000 Sq Ft 450,000 Sq Ft 450,000 Sq Ft 1,500,000 Sq Ft 225,000 Sq Ft EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE
- 16. From Pre-design Study to Post Occupancy Evaluations TARGET 2012 Construction of Phase 2 projects is Banner Health completing or near complete in 2011 Phoenix, AZ Post Occupancy Evaluation Research Seidman Cancer Center Target Post Occupancy Evaluations for Cleveland, OH 2012 Post Occupancy Evaluation 2010 2012 Potential comparative study of three complete projects Projects Seidman MD Anderson Cancer Hospital Banner Cancer Center 450,000 Sq Ft 225,000 Sq Ft EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE
- 17. Research Road Map PHASE 1 PILOT STUDY VERIFICATION WE ARE HERE PRE-DESIGN STUDY PHASE 2 VERIFICATION PHASE 2 EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE
- 18. 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 EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE
- 19. 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 Potential Design Solutions: -Multiple HVAC zones -Multiple types of treatment station 1. Image Digital Thermostat. Accessed 5/17/2011 http://digitalthermostat.org/ EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE
- 20. Summary of Findings: Privacy and Social Support Private treatment rooms preferred by 50% if survey participants, remaining split 28% always choose shared and 22% flexible depending on treatment day. Sometimes 28% Private 50% Gender and geographic changes in preferences affect the balance of private and shared treatment Share 22% spaces. Potential Design Solutions: n = 161 - Multiple types of treatment spaces EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE
- 21. Summary of Findings: Positive Distractions “What amenity would you prefer?” Guest Chair 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 Potential Design Solutions: -Plan for a guest chair at each treatment station -Family lounge space for guests and social interactions EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE
- 22. Summary of Pre-design Research and Design Ranking Design Strategies Patient Needs 1 Patient Control and Choice 1 Treatment Station Typology 2 Window View 2 Privacy and Social Support 3 Family Lounge 4 Way-finding 3 Positive Distractions 5 Access to patient toilets EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE
- 23. Design of Simon Cancer Center Development of design strategies EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE
- 24. Simon Cancer Center | Indianapolis, Indiana 1. Brian Drumm photo courtesy of IUPUI Communications and Marketing EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE
- 25. Simon Cancer Center | Indianapolis, Indiana 28,500 Square Foot Infusion Center 60 Patient treatment stations Treats most types of caner with exception of Bone Marrow N Located Downtown Indianapolis, Indiana 1. Google Maps. Accessed 5/18/2011. www.maps.google.com EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE
- 26. Simon Cancer Center | the Infusion Center Roof top garden Nurse work station Fireplace lounge area Open Bays for patient and guest interaction Private Rooms EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE
- 27. Simon Cancer Center: Choice on Privacy or Open Most cancer centers use fabric curtains to separate open bays, Simon the team designed movable screens between patient bays EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE
- 28. Simon Cancer Center: Fireplace Lounge Area EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE
- 29. Post Occupancy Evaluation of Simon Cancer Center Investigate the significance of design strategies EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE
- 30. 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 EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE
- 31. Simon Cancer Center: Research Timeline 2009 2010 2011 EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE
- 32. Simon Cancer Center: On-site Observation EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE
- 33. Simon Cancer Center: Questionnaire Survey Participants answered surveys while in the space EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE
- 34. Simon Cancer Center: Findings Typology of Access to treatment Patient Window Way- stations Toilets View finding Distances Privacy Un-Stress Comfort Satisfaction Hope Significantly related, p<0.02 EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE
- 35. Simon Cancer Center: Typology of Treatment Stations Private treatment rooms Semi-open treatment Open treatment 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 EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE
- 36. 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. EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE
- 37. 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. EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE
- 38. Simon Cancer Center: Access to Patient Toilets Semi-open treatment stations and shared patient toilets Private treatment rooms and shared patient toilets EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE
- 39. 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 EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE
- 40. 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. EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE
- 41. 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. EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE
- 42. Summary of Findings: Significant Design Strategies Design strategies Ranking by significance in POE 1 Treatment station typology 1 Treatment station typology 2 Window View 2 Access to patient toilets 3 Family lounge 3 Window View 4 Way-finding 4 Way-finding 5 Access to patient toilets 5 Family lounge EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE
- 43. 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. EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE
- 44. 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 EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE
- 45. EXPERTISE IMAGINATION PARTNERSHIP PERFORMANCE