Cancer centers: Designing away fear

For many of us, mortality is a remote concept, but for cancer patients it is an ever-present reality.

Patients with cancer are forced to confront their condition while they are experiencing the brutal effects of both the disease and the treatment. Although functional design is essential to a healthcare environment, innovative designs for cancer treatment centers need to focus on the patient’s emotional support. The design of cancer centers is critically important to reinforce their right to quality of life and enhance their commitment to the healing process, while encouraging them to embrace the present moment.

At E4H we are seeing increasing demand for unique cancer care facility designs, with hospitals choosing to invest heavily in this type of building and renovation. Here are a few design best practices when taking on this type of project.

A Different Kind of Care
Cancer care often consists of a repetitive treatment routine. A chemotherapy regimen frequently occurs on a scheduled time on a recurring basis, while one sits in a chair for 2-4 hours or longer. Patients become familiar with the routine, the treatment’s protocols and sometimes, they develop a support group with other patients. The space therefore must be designed to provide maximum, sustained comfort, and to facilitate this bond with other patients, enabling the ability for privacy as well as social interaction when desired. This can be accomplished with moveable partitions, curtaining, or shoji screens.

Another differentiating feature of cancer centers is the lack of ‘waiting’ areas at check in and check out. By providing minimal furnishings that discourage sitting and long waits, patients and their care givers check in and almost immediately proceed to their treatment area. This changes the overall atmosphere and lets patients know they are expected and that their utmost comfort and care is being considered. Once checked in, patients proceed to their treatment area and care givers typically adjourn to a light filled “living room” that adjoins the treatment area for easy proximity to their loved one.

Designing the Fear Out
The use of light, warm materials, and fabrics are essential to reinforcing the quality of life deserved by all and to mitigate the fear that comes with diagnosis and treatment. Many designs today situate infusion suites near windows and gardens, with as much access as possible to the outside environment, which becomes part of the design.

Radiation treatment tends to be conducted in vaults made from thick concrete and kept at a very cold temperature. These can be frightening spaces, behind big heavy doors, where patients can feel trapped and isolated. Whenever possible the design should break down the bunker-like nature of the space. Incorporating murals of natural landscapes or images of rebirth can inspire hope: bringing the natural environment into the space as much as possible provides a reassuring context. Finishes such as these can also reflect the distinct culture of each healthcare institution, its brand, approach and values. If located in a courtyard, vs. buried in the basement of a building, for example, a light well can be built into the ceiling, or a Japanese Zen garden can be situated within the space.

Sanctuary
Many hospitals include a space of sanctuary; a chapel or meditation space where patients, family members, friends and caregivers can go for quiet contemplation, prayer or comfort. In designing spaces for cancer care, however, we believe that those same principals should apply to the entire facility, not only to one designated space within it. The characteristic elements of comfort, warmth, quiet and connection to the natural world should imbue all spaces for patients, caregivers and family and friends. The overall space can foster a connection to the immediate environment, be comforting and encouraging, and help endow them with a sense of peace.

To create a more effective sanctuary, we often include design elements aimed at respecting and addressing a variety of cultures that may be present in the treatment center’s vicinity. For example, some patients may just be dropped off for an infusion, while others may be accompanied by a large extended family packing a lunch. Both the treatment spaces and family waiting areas should sensitively address this range of cultures inherent in the service area’s demographics.

Supporting caregivers
Taking care of patients with cancer can exact a great emotional toll on staff. According to a recent study done at Memorial Sloan-Kettering Cancer Center, 44% of inpatient oncology nurses reported some degree of burnout. Their needs can’t be overlooked. Spaces must be designed to uplift them and to sustain them as they deal with the everyday strain of providing care; to put them in the best possible position to care for cancer patients. This requires designing spaces where caregivers gather to address the problems of the day, share collegial support, information and analyze issues, exchange emotional support, and relax.

As an example, nurse stations should be placed in close proximity to patient areas. They need to be flexible, open and accessible to patients and caregivers to allow for more integration and communication. Areas of respite allowing relaxation and privacy from patients should also be provided.

Lastly, cancer care is a fast-changing environment, with new therapies and treatments coming online monthly. Patient education is a key predictor for success. Educated patients are more empowered and more positive about their treatment plans. Because this can help bolster outcomes, architects today need to take into consideration how to incorporate easy access to patient education tools such as libraries and internet connectivity. By including elements such as sanctuaries, family living rooms and libraries, cancer treatment centers can be much more than sterile treatment environments: they can be designed to treat the whole person, not just the cancer patient.

Chip Calcagni
Chip is a managing partner of E4H Environments for Health. A practicing architect for over 27 years, Chip's experience includes the design of high-end medical and research spaces and laboratories for major healthcare institutions. He has led the design of cancer centers, inpatient beds, surgery centers, and emergency departments.

E4H
E4H Environments for Health is a nationwide healthcare architecture and design firm focused exclusively on healthcare. E4H has worked with many premier cancer treatment centers for nearly 20 years, including Memorial Sloane Kettering, MA General, Sister Caritas, and Eastern Maine Medical Center, among others.

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