Mind and body

>Health care design requires special expertise from all project professionals. Architects, interior designers and engineers must consider many issues when patient care is involved, but designing facilities specifically for cancer patients elevates that level of expertise due to the many complex issues facing cancer patients and their families.

Cancer patients are a diverse population with one common thread: receiving the care that will cause the cancer to be cured or go into remission.

To accommodate this vast patient population, design professionals must create an environment that supports patients' physical and psychological needs. They need to have their fears curbed, their anxieties subdued and their confidence built.

Thoughtful design

Comprehending a diagnosis of cancer is life-changing. Being able to digest it and make sense out of the myriad of treatment options, possible complications, financial obligations and future outlook can be daunting. Design professionals who help create cancer centers must never lose sight of this. A cancer facility needs to provide exceptional care as well as support the special physical and psychological needs of patients and their loved ones.

For example, spaces that feature soothing reminders of nature seem to resonate with most patient populations. Ways to accomplish this can involve incorporating natural light; wood or wood-like products; lighting features that mimic the sky; products that use natural elements that could be indigenous to the local area, such as embedded sea grass in a facility near the ocean; and artwork that is neither confusing nor could be misunderstood and, therefore, create a sense of anxiety or frustration.

During the early diagnosis stage, patients often are in an exam room for hours at a time while physicians from different modalities meet with them. Successful designs of these multidisciplinary exam rooms often incorporate elements that will help to eliminate anxiety and boredom.

Providing on-site amenities for cancer patients can be very helpful. Many cancer centers offer spaces that incorporate alternative medicine such as massage and acupuncture; and aesthetic boutiques, which specialize in prostheses and other wellness-related items such as wig-fitting and styling rooms and private dressing rooms. Conference centers that can be subdivided into smaller rooms also should be part of the facility. The conference center should have the flexibility to accommodate large lectures or small support groups and educational functions. The rooms should be located near the entrance to the facility so events held in the evening hours are easy to find.

During a potentially exhausting day, patients and their families will appreciate the convenience of having food and beverages on-site. A small café located within the lobby that can support gourmet coffee, juices, yogurt and sandwiches can save families valuable time from having to retrieve nourishment in the main hospital cafeteria or braving the elements going to an off-campus facility. If the café is incorporated into the initial design, this will prevent unsightly coffee carts from appearing haphazardly in the future.

Access to outdoor spaces can be invaluable — often, having a breath of fresh air and seeing a blue sky can refresh the mind and spirit. If space and budget allow, cancer centers should incorporate outdoor gardens and patios.

Particularly important is access to outdoor space off the infusion suite. Especially in warm weather, giving patients who spend the better part of the day confined to one area access to a garden setting will break up the monotony. When selecting plantings, design professionals should keep in mind that during winter months the garden still needs to have visual interest, color and texture. If not carefully selected for its interesting texture or bark, the use of all deciduous trees and bushes may make for a dull garden in many U.S. climates in January.

Artwork is an essential component that should be planned and properly budgeted during the initial stages of design. While water features are prohibited from cancer centers, art that promotes a feeling of hope and happiness needs to be at the forefront. Many patients might feel confused looking at abstract art, thus adding to their stress level. A dark or cloudy sky in an otherwise beautiful landscape can promote a feeling of negative anticipation. A sole chair positioned in a meadow might make someone feel lonely. These details need to be carefully considered when selecting art.

Incorporating equipment

Equipment coordination is a particularly important part of any cancer center project. Linear accelerators, positron emission tomography/computed tomography (PET/CT), simulator rooms and brachytherapy rooms all require designers to take into account the placement and types of equipment required in these spaces for them to function properly. Some of the many issues to discuss include shielding requirements, millwork design, physicist-testing requirements, laser placement, structural support, mechanical-electrical-plumbing and sprinkler locations, and camera and monitor locations.

Millwork is especially critical and needs to be able to accommodate an assortment of specialized items like body molds and face masks. Custom shelving will need to be incorporated to accommodate these specific items. Flooring often will need to be static dissipative, which significantly narrows the choice of products that will be aesthetically pleasing and still meet the technical requirements.

Because these types of spaces can be physically large, it is important to incorporate design elements that bring the scale down to a more manageable size. They need to be designed to feel less intimidating to patients when they enter and when they are inside. Patients usually are frequenting these spaces every day sometimes for months at a time, so it is especially important to remember that if it is an unpleasant experience at first, it likely will be unpleasant for the length of their treatment.

Those involved in the project not only must have the special skills required to provide services to build and support a cancer center, but they also must remember that their efforts benefit each of the cancer patients.

Infection prevention

All of these design opportunities must be considered within the exceptionally important area of infection prevention. It is common to have this concern in mind when designing many parts of any health care environment. However, with cancer patients, it is especially critical.

Horizontal ledges, reveals or crevices — virtually anyFacilities operations, Patricia A. Damiri, interior design, interiors, hospitals, cancer, cancer centers, finishes, materials, construction, building, mock-ups, infection prevention area that is not easy to clean or can collect dust — can be detrimental to a cancer center. Beautifully designed caregiver stations with inserts are sure to be magnets for dirt.

Recessed horizontal reveals at high locations above door frames also are a concern, because they are not easy to clean due to their height. Decorative lighting fixtures that do not have a top on the diffuser to prevent insects and dirt from collecting inside will be problematic. Floating drywall soffits may look interesting in the photographs, but how will someone get up there to wipe off dust? These are only a few of the many things to consider.

Many health care facilities have a difficult time keeping up with regular maintenance, so creating a design that is easily maintained will cut down on many concerns for the most vulnerable of patients receiving care. The motto should be: "If it can't be cleaned easily, effectively and effortlessly, then it should not be used in a cancer center."

Other issues

When assessing the physical and psychological needs of cancer patients, it is critical for designers to understand all sides of this complex issue. Some considerations to be well-thought-out prior to any space planning include the following:

• Many cancer patients are immunocompromised and physically weak. Traveling major distances can be problematic for them. Consequently, the location of each modality in relation to the front entrance is very important.

• Patients, especially young ones, are psychologically sensitive about their condition. Incorporating ways to provide the most private and dignified way to receive treatment is an especially important issue.

• Some oncologists feel strongly about whether they can share certain spaces with other oncologists or will require their own. Understanding exactly how each oncologist functions in the most efficient manner will aid in the most efficient use of space.

• Structural issues must be considered with regard to the location of the linear accelerator and PET/CT rooms because these rooms have very specific size requirements that need to be column-free. Hot labs need to have lead-lined walls, their own dedicated toilets and cannot be located too far away from the PET/CT room itself.

• Infusion areas should be positioned to have the most natural light, but as much privacy as possible. The face of every patient also should be visible to the nursing staff.

• Other modalities such as breast centers may need to be incorporated into the cancer center, even though not all of these patients have cancer. Their locations and their incorporation into the overall design need to be carefully thought out.

Solving the puzzle

The interior design effort for a cancer center is a puzzle — every piece has its own needs, but the goal is to create an environment where patients can feel as comfortable as possible. Once a successful space plan is devised, the facility will be on its way to being exceptional.

Patricia A. Damiri, LEED AP, AAHID, is associate principal at Mitchell Associates, Wilmington, Del. She can be reached at pdamiri@mitchellai.com.