Environments for Cancer Infusion CarePresentation Transcript
Cannon Design Research:Environments for CancerInfusion Care - QualitativeResearch of Opinions andObservationsPresented by:Zhe Wang - Principal InvestigatorAshley Farell – Research AssociateResearch Team:Natalie Petzoldt, Jennifer Cayton, Michael Pukszta,Peter Hourihan
Learning Objectives- To identify environmental needs among cancer patients, companions and nursing staff- To learn research-informed environmental design strategies for cancer care- To discuss the importance of research on ambulatory healthcare environments- To promote qualitative research tools for design research
Environments for Cancer Care – Qualitative Research ofOpinions and Observations1. Context2. Project Information3. Research Introduction4. Surveys5. Observations6. Discussion and Conclusion
ContextThe cancer patient population in the United States grows by1.5 million each year (American Cancer Society, 2009). Americans have made measurable success in battling cancer and increased the relative 5-year survival from 50% in 1970s to 66% in 2009.
Infusion CareThe typical healthcare patient Event Diagnosis Health Treatment Infusion treatment: 50+% cancer patients undergo chemotherapy1 Time
Infusion CareThe oncology patient Event Diagnosis Health Treatment Potential 100 trips in the first year after diagnosis Time
Infusion Bays Karmanos Cancer Institute University of Maryland Medical System Weisberg Cancer Center, Tate Cancer Center, Detroit, MI Glen Burnie, MD Architect – Cannon Design Architect – Cannon Design
Project Information Clarian Health Partners / Indiana University – Cancer Hospital, Indianapolis, IN, Architect – Cannon Design • The 28,500 square-foot new infusion center opened in September 2009 with 40 treatment stations in the three types.Roof top garden Shelled INFUSION PHARMACY IDS PHARM. Shelled PHLEB PHLEB PHLEBDaylight and view
Typology of Treatment StationsPrivate treatment roomsSemi-open treatment Open treatmentThe Telegraph. Access 5/19/2011 http://www.telegraph.co.uk/health/healthnews/7520628/Thousands-of-NHS-patients-dying-needlessly-expert.htmlIntegrative Focus, Inc. Accessed 5/19/2011 http://intergrativefocus.com/services/small_bytesMass General Cancer Hospital Accessed 5/19/2011 http://www.massgeneral.org/cancer/about/newsarticle.aspx?id=2487With Friendship.com Accessed 05/22/2011. http://withfriendship.com/user/boss/chemotherapy.php
Project InformationOpen Area: Fireplace Lounge Area
Project InformationSemi-Private: Most cancer centers use fabric curtains to separateopen bays, Simon the team designed movable screens betweenpatient bays.
Research IntroductionTeam: InterdisciplinaryQuestions:1. Private Room, Open Area, or Semi? - What do Patients, Companions, and Staff Prefer and Why2. How do they use the environments?
Research Introduction• Surveys: 165 patients, 139 patient companions, and 16 nursing staff - June 2010.• Observations: two-day direct observation in the Simon Infusion Center - May 2010. Image sources: www.imr.no
Research Introduction Literature review findings Cancer inpatients Single-bed inpatient rooms - like to share a room. - reduced nosocomial infection rates. - prefer an open area of care - more privacy and flexibility in - chose double-bed rooms. operation - more satisfied.Image source: http://wesleymc.com/our-services/infusion-center/infusion-center.dot
SurveysWhat did we ask?If I could choose the environment to receive my infusiontreatment, I prefer____A private room with no other patients____A semi-private area (e.g., with other patients and retractablescreen or curtain)____An open area with other patients receiving chemotherapytreatmentThe reason for me to make the aforementioned choice is…
SurveysWhat did we ask?During my infusion treatment, Among the following items,the THREE MOST IMPORTANT ITEMS to me are__Good window view __Pleasant sunshine __Take a nap__TV/ DVD __Music/ radio __Books/ magazines__Food/ beverages __Phone access__Computer / wireless access __Interior decoration including artworks on the wall
SurveysThe answers Open Area Private Room Private Room Open Area , 39 Private Room Private Room Open Area , 58 Open Area , 97 , 50 , 43 , 94 Semi-private Semi-private Area Semi-private Semi-private Area , 45 Area , 43 Area , 101 Patients Companions Staff Total (165 total) (139 total) (16 total) (320) number percentage number percentage number percentage number percentage Private Room 50 30% 43 31% 1 6% 94 29% Semi-private Area 45 27% 43 31% 13 81% 101 32% Open Area 58 35% 39 28% 0 0 97 30% No preference 12 14 2 28
Surveys Patients Companions Staff Total (165 total) (139 total) (16 total) (320) The answersPrivate 33 answers /50 26 answers /43 1 answer /1 60 answers /94 Room Top Keywords frequency frequency frequency frequency Privacy 12 11 23 Nap/sleep 11 2 13 Family Socialization 5 12 1 18 Sound/noise 4 6 10 Bathroom 4 1 5 Semi- 17 answers /45 22 answers /43 11 answer /13 50 answers /101 private Socialization 12 8 5 25 Area Privacy 5 10 4 19 Patient-nurse access 4 4 6 14 Spatially-open area 1 3 4 Open 24 answers /58 27 answers /39 0 answer /0 51 answers /97 Area Socialization 15 17 32 Spatially-open area 4 5 9 Window/natural light 4 4 8 Patient-nurse access 1 4 5
SurveysSample answers to the preferences“A private room offers a better opportunity for nappingwhen Im having severe fatigue; …sometimes I sleep; Iwould sleep.”“Family members come along to support her and aprivate room enables us to keep her spirits uplifted; Inorder to have more private conversations; Like privacy -able to have personal discussions.”
SurveysSample answers to the preferences“I enjoy the distraction of business with some degree ofprivacy; I want to be around others, but be private too;“I like being visible to the RN station but not all of the otherpatients; It is for the nurses interact w/other patients;“Often we speak with one another (nurses andpatients) and its a pleasant atmosphere; I like to shareinfo with other patients.”
SurveysImportant items to PatientsPositive distraction during infusion treatment1. Taking a nap2. Television3. Food/beverages4. Good window view and natural light were also popular among the patients who stayed in or preferred a semi-private/open treatment. Image source: http://www.nytimes.com/2009/07/30/us/30nap.html?_r=1; http://www.drcrayton.net/infusion-center.html;
SurveysImportant items to PatientsImportant items to control1. Personal television2. Temperature/angle of the treatment recliner3. Temperature and sound level of the area Image source: http://www.nytimes.com/2009/07/30/us/30nap.html?_r=1; http://www.drcrayton.net/infusion-center.html;
SurveysCompanion and Staff AnswersCompanions:1. Comfortable seating2. Television3. Food/beverage4. Good window view and natural lightStaff:1. Proximity to treatment stations/medical supplies/pharmacy2. Views to patients3. Access to computers /wireless
Summary of survey findings• A variety of treatment spaces• Semi-private and/or open areas were preferred by most survey participants including patients, companions and staff (strongly).• High privacy, a quiet place to sleep, and family support.• Opportunities to socialize, feeling of openness, and access to nature.
Typology of Treatment StationsDuring observation, patientsconsistently choose seats at end ofsemi-open treatment space first.Then, they choose the seats in themiddle.The last seats chosen were always inbetween other patients.
Observation Background- Observers studied patient, staff and companion behavior and how they interacted with the infusion environment- The following pages contain several design features that stood out as significant to designers and researchers- Each page contains the design intent, how the features were actually used, and suggestions for future projects. Every feature in this packet is meant to start a discussion and provoke ideas. The suggestions are not meant as prescriptions for future infusion spaces.
Reception DesksDESIGN: A ratio of one desk per pod (average of 20treatment stations) was used, resulting in threereception desks for the infusion center.
Reception DesksUSE: One desk designed for infusion information isbeing used as a community information area. Only oneof the remaining desks is used by both open pods, theother is not used because of operational changes at theinfusion center.
Reception DesksFUTURE: Decrease the number of reception desks. IUis more efficient than anticipated, so one desk per podis not necessary. As many hospitals incorporate digitalkiosks, the number of receptions desks may decrease.
Waiting RoomDESIGN: Long room with lots of seating, expansivewindow views and daylight. 30-40 chairs wereprogrammed for each pod, for a total of 120 chairs in thewaiting area. The area was planned for peak timewaiting, when many patients wait after their blood drawand before treatment occurs.
Waiting RoomUSE: IU has implemented electronic medical recordsand efficient intake and processing which requires lesswaiting. Some visitors use this space for talking on thephone while patients are being treated.
Waiting RoomFUTURE: Smaller waiting rooms or decentralizedwaiting should be considered..
Consult RoomsDESIGN: Consult room was separated from thetreatment pod to be accessed from waiting.
Consult RoomsUSE: These rooms were underutilized duringobservation; much of consultation is done at thetreatment stations.
Consult RoomsFUTURE: Consult rooms should be accessed orlocated within the treatment area, so patients don’t feellike they are leaving the infusion center when they gofor a consult.
Treatment LoungeDESIGN: Four recliners arranged near a faux fireplaceoffer patients and companions social opportunitiesduring treatment.
Treatment LoungeUSE: Not used for infusion treatment because ofnursing preference. Patients are not given the choice tosit here for treatment. It is used on a limited basis bycompanions.
Treatment LoungeFUTURE: Consider alternative spaces for treatment toenhance socialization and to provide respite forcompanions.
Toilet to Semi-Private Room RatioDESIGN: A 1:6 ratio of patient toilet rooms toopen treatment bays. T T
Toilet to Semi-Private Room RatioUSE: Ratio seemed adequate as no patientswere seen waiting during observations and thiswas not noted as an issue on questionnaires. T T
Toilet to Semi-Private Room RatioFUTURE: Recent projects such as King Faisaland BMDACC used a 1:4 ratio, although a 1:6ratio was appropriate here. T T
Nurse Stations Station for semi-private rooms Station for private roomsDESIGN: Two nurse stations per pod; onenurse station for semi-private rooms and onefor private rooms.
Nurse Stations Station for semi-private rooms Station for private roomsUSE: Nursing ratios do not require staff to fullyutilize second nurse station. Only the nursestations for semi-private rooms were utilized bynurses, while nurse technicians use the stationintended for private rooms.
Nurse Stations Station for semi-private rooms Station for private roomsFUTURE: Consider placement of nurse stationsto provide maximum visibility to all stations androoms.
Ratio of Private to Open RoomsDESIGN: 1 private room : 2 semi-privaterooms
Ratio of Private to Open RoomsUSE: This ratio worked well for the patientpopulation at Simon Cancer Center. It mayvary by geographic location.
Ratio of Private to Open RoomsFUTURE: Research should be done witheach project through interviews, focus groupsand questionnaires to best understand thepopulation and specific needs of thatprogram.
Discussion and ConclusionSurveys clarified the preferences and the importance in the users.On-site observations helped to better understand clients’ use of design.
Questions, Answers, DiscussionFor more information please contact: Zhe Wang Ashley Farell Cannon Design – St. Louis Cannon Design – St. Louis 314-425-8708 314-425-8732 email@example.com firstname.lastname@example.org