Research-informed Design of the Simon Cancer Center

© CANNON DESIGN 2010

Expertise Imagination Partnership Performance

A N I D E A S B A S E D P R A C T I C E


Start your research engine!Research-informed Design of the Indiana University Simon Cancer Center



American Cancer Society 2009 Facts and Figures

1.5 million Americans diagnosed with cancer annually

Second leading cause of death

65% five-year survival rate

1. American Cancer Society, “2009 Cancer Facts and Figures.” http://www.cancer.org/downloads/STT/500809web.pdf Accessed 05.21.2010

90 % of the people in this room have been impacted by cancer

CANCER



THE TYPICAL HEALTHCARE PATIENT

Time

Health

eventDiagnosis

Treatment



THE ONCOLOGY PATIENT

Time

Health

eventDiagnosis

Treatment

100 Trips



EVIDENCE BASED DESIGN | ONCOLOGY



2000 2003 2006 2009 2012

Infusion Design Research Timeline | 10 Year Snapshot

2007Karmanos Cancer CenterDetroit, MIFocus GroupsPatient Interviews & Surveys

2005Cancer Center of MaineBangor, MEFocus GroupsPatient Interviews & Surveys

2004Todd Cancer InstituteLong Beach, CAFocus GroupsPatient Interviews

Res

earc

h1999-2000Siteman Cancer CenterSt. Louis, MOFocus GroupsPatient Interviews 2003-2005

Clarian/IU Simon Cancer CenterIndianapolis, INFocus GroupsPatient Interviews

2007Banner HealthPhoenix, AZPatient QuestionnairesFocus Group

2008Northwestern UniversityChicago, ILPatient Questionnaires

UH Case Medical CenterCleveland, OHPatient QuestionnairesFocus Group

2010Clarian/IU Simon Cancer CenterIndianapolis, INPost Occupancy Evaluation

Other Targeted Phase 1 Sites

TARGET 2011Banner HealthPhoenix, AZPost Occupancy Evaluation

UH Case Medical CenterCleveland, OHPost Occupancy Evaluation

Proj

ects

BJC / Washington UniversitySiteman Cancer Center

750,000 Sq Ft

Indiana University Simon Cancer Center

450,000 Sq Ft

UH Case Medical Center Cancer Hospital

450,000 Sq Ft

MD AndersonBanner Cancer Center

225,000 Sq Ft

Karmanos Cancer InstituteWeisburg Cancer Center

25,000 Sq Ft

King Abdullah Saudi Arabia

1,500,000 Sq Ft



Infusion Design Research Timeline | 10 Year Snapshot

PHASE 2Ban

ner H

ealth

Phoe

nix,

AZ

UH C

ase

Med

ical

Cen

ter

Clev

elan

d, O

H

North

weste

rn U

nive

rsity

Chic

ago,

IL

Karm

anos

Can

cer C

ente

r

Detro

it, M

I

Canc

er C

ente

r of M

aine

Bang

or, M

E

Todd

Can

cer I

nstit

ute

Long

Bea

ch, C

A

Clar

ian/

IU

Sim

on C

ance

r Cen

ter

Indi

anap

olis

, IN

Site

man

Can

cer C

ente

r

St. L

ouis

, MO

PHASE 1PILOT STUDY

Clar

ian/

IU

Sim

on C

ance

r Cen

ter

Indi

anap

olis

, IN

Targ

eted

Pha

se 1

Site

PHASE 1 VERIFICATION

TARG

ET 2

011

UH C

ase

Med

ical

Cent

erCl

evel

and,

OH

TARG

ET 20

11

Bann

er M

D An

ders

on

Phoe

nix,

AZ

PHASE 2VERIFICATION

FUTU

RE P

ROJE

CT

FUTU

RE P

ROJE

CT



OUR RESEARCH TEAM |

Zhe Wang - PhD Researcher(Nick Watkins, PhD)

Natalie Petzoldt - Healthcare Architect

Jen Cayton - Architectural Intern



OUR RESEARCH TEAM |

Brains

Experience

Cheap Labor



Measure and EvaluateDesign Hypothesis

Informed the design criteria and made a hypothesis

OUR RESEARCH PROCESS |

Identified a research question

Started Pilot StudyQualitative ResearchPatient Focus GroupsPatient Interviews

Refined our ProcessQuantitative ResearchPatient Questionnaires



Measure and EvaluateDesign Hypothesis

Patients who are interacting with other

patients during treatment have improved wellbeing

OUR RESEARCH PROCESS |

Can infusion center design impact pts

emotional wellbeing?

Talk to the patients, family and staff what is

important to them

Survey patients in different environments

to see if emotional wellbeing changes



CANNONDESIGN PILOT STUDY | PHASE 1 & 2SUMMARY OF RESULTS – INFUSION CENTER DESIGN



Qualitative Quantitative

PILOT STUDY



Location Summary

Clarian IU Simon Cancer CenterIndianapolis, Indiana

Todd Caner CenterLos Angles, California

Siteman Caner CenterSt. Louis, Missouri

Karmanos Cancer InstituteDetroit, Michigan

Cancer Care of MaineBangor, Maine

MD Anderson Banner HealthPhoenix, Arizona

Case WesternCleveland, Ohio

NorthwesternChicago, Illinois

PILOT STUDY

Todd Cancer CenterSiteman Cancer Center

Karmanos Cancer Institute

Clarian-IU Cancer Hospital

Cancer Care of Maine

Case/Ireland Cancer InstituteNorthwestern

MD AndersonBanner Health

Phase 1

Phase 2



MDA Banner Health

Case Western

Fe-male76%

Male24%

Gender

Location Summary

MD Andersion Banner HealthPhoenix, Arizona



n = 161

n = 30

n =69

n =61

PILOT STUDY | PHASE 2

Northwestern

Female100%

Male64%

Female36%

Male43%

Female57%

PILOT STUDY



PILOT STUDY | PHASE 2 Location Summary




n = 138

Cancer Type

Ovarian

Other

Blood or Lymphatic

Cervix, Ovary, Uterus

Breast

Colon or Rectum

Lung

Multiple

Brain, Neck or Head

Stomach

Case Western Lung

Other

Multiple

Breast

Ovarian

Colon or Rectum

Brain, Neck or Head


Blood or Lymphatic

Stomach

MDA Banner Lung

Other

Multiple

Breast

Ovarian

Colon or Rectum

Brain, Neck or Head


Blood or Lymphatic

Stomach

Other50%

Blood & Lymph

42%

Breast8%

Northwestern Lung

Other

Multiple

Breast

Ovarian

Colon or Rectum

Brain, Neck or Head


Blood or Lymphatic

Stomach

Ovarian57%

Other22%

Blood &Lymphatic

28%

Cervix, Ovary26%

Blood & Lymph

23%

n = 65

n = 12

n = 65

Ovarian18%

Colon15%

Cervix,Uterus

15%

PILOT STUDY

Other28%

Breast15%



Location Summary





n = 133

n = 22

n =59

n =52

Under 306%

30-397%

40-4918%

50-5923%

60-6925%

70-7919%

80 and over2%

Age

MD Anderson Banner Under 30

30-39

40-49

50-59

60-69

70-79

80 and over

Case WesternUnder 30

30-39

40-49

50-59

60-69

70-79

80 and over

NorthwesternUnder 30

30-39

40-49

50-59

60-69

70-79

80 and over

40-49

50-59

60-69

70-79

40-49

30-39

60-69

70-79

40-49

50-5960-69

70-79

PILOT STUDY



Q: What amenity would an infusion patient most want?

A: A Nice View

B: Their Own TV

C: Privacy From Staff

D. A Guest Chair




A: A Nice View

B: Their Own TV


D. A Guest Chair

0% 50% 100%

60%




A: A Nice View

B: Their Own TV


D. A Guest Chair

54%

0% 50% 100%

60%




A: A Nice View

B: Their Own TV


D. A Guest Chair

54%

3%

0% 50% 100%

60%




A: A Nice View

B: Their Own TV


D. A Guest Chair

54%

3%

90%

0% 50% 100%

60%

| ENVIRONMENTAL CONSIDERATIONS

Amenities DistractionEnvironment

ENVIRONMENTAL CONSIDERATIONS

Environment



Private Open

vs



PATIENT PERSPECTIVES

Location Summary





Priv

ate

Ope

n

Priv

ate

Ope

n



Location Summary





PILOT STUDY

Private50%

Share22%

Sometimes28%

What type of room do you desire?

n = 161

Statistically no relationship between type of room they were in vs type of room desired

Case Western

Private

Share

Sometimes

MD Anderson Banner

Private

Shared

Sometimes

n = 31

Private

Private

n = 69

Northwestern

Private

Share

Sometimes

n = 61

Private

27% Private

67% Private




If open infusion areas are appropriate, what is the “right number” of patients to be put together?”

Location Summary





PILOT STUDY




“If I am receiving infusion in an open area, what is the “right number” of patients to be put together?”

A: 2 to 3

B: 3 to 5

C: 5 to 7

D. 7 TO 10

E. More than 10

Location Summary





Chart Title7 to 10

6%

PILOT STUDY

2 to 339%

3 to 536%

5 to 719%





Patient Interviews:

Location Summary





• Vast Majority of patients stated that two chairs per room was not desirable, as they may not like the person adjacent to them.

PILOT STUDY

Chart Title

2 to 339%

3 to 536%

7 to 106%

5 to 719%



Chart Title



Patient Interviews:

• If 2 patients per area is eliminated….

Location Summary





2 to 339%

3 to 536%

7 to 106%

5 to 719% X

PILOT STUDY



Chart Title



Patient Interviews:

Location Summary





• Three- Five chairs per shared treatment area seems most appropriate.

PILOT STUDY

3 to 575%

7 to 106%

5 to 719%



Drill Deeper on Patient Environment

1. Temperature Control

2. Light Control

3. Visibility from staff

4. Reading Light

5. Quiet Environment (No TV / Radio Allowed)

6. Privacy from Staff

54%

3%

59%

0% 50% 100%

37%

48%

15%

PILOT STUDY




Amenities



53%

0% 50% 100%

26%

34%

25%

Survey of Infusion Patients:

Drill Deeper on Patient Amenities:

1.Access to Food/Drink

2. Coat Hangers/Closet

3. Wireless Internet

4. Blanket or Pillow



Location Summary




PILOT STUDYPHASE 2

PILOT STUDY

Never28%

Briefly31%

Some of the time33%

Most of the time9%

Patient who eat during treatment

n = 183



Never52%

Briefly26%

Some of the time17%

Most of the time5%

Amount of time patient napped

Location Summary





PILOT STUDY

n = 157




Distraction



Survey of Infusion Patients:

Drill Deeper on Entertainment / Positive Distractions:

1. A Guest Char

2.A Nice View

3. Their own TV

4. Radio

5. DVD Player

6. Artwork

7. Shared TV

54%

19%

0% 50% 100%

60%

31%

40%

23%

90%



Own bathroom

Parking

Other

Food

Music

Parking

Colorful Décor

View to nature or art

Chair

0% 5% 10% 15% 20% 25% 30%

Write-In Patient desired amenities

Location Summary





PILOT STUDY

n = 76



Never35%

Briefly19%

Some of the time26%

Most of the time19%

The entire time2%

Patient who read during treatment

Location Summary





PILOT STUDY

Never43%

Briefly8%

Some of the time11%

Most of the time16%

The entire time22%

Watched Television

n = 141 n = 160

Distracted by others



Location Summary





PILOT STUDY

0

1

2

3

4 5

Number of guest(s) who came with patient

n = 157

MD Anderson Banner

Cleveland

Northwestern

0

1

23

45

0

1

2

34

n = 31

n = 67

n = 60

01

2 3

50% brought 3 or more

90% brought 1 or less

6,7,8



Location Summary





PILOT STUDY

Patients like being the only one in room

Agree24.3%

SomewhatAgree17.8%

Neutral26.2%

Disagree19.6%

“Sometimes I like to share treatment space. It

makes me sad when a patient in the other chair

has died. We become friends with the other

patients when you spend a lot of time together.”

- infusion patient

n = 132

SomewhatDisagree

12.1%



DISTRACTIONS

Location Summary







Ho p e fulfo r Tre a tm e nt

26%

Se d a te

Anxio us

I Im p a ire d

Ill a t Ea se

Hung e r a nd Thirst

Inte ra c t with G ue sts

Inte ra c t with Pa tie nts

Am b ia nc e

De nsity

Distra c tio n

O utsid e

Priva te Ro o m Pe rks

De sig n Ra ting s

Tre a tm e nts in c yc le

Pro je c te d ho urs In se ssio n

# o f p a tie nts in

Ro o m

# o f G ue sts in

Ro o m

To ta l # in ro o m

-0.5

0.37

11%

0.37

12%

20%0.47

0.35

38%

-0.57

R= -0.4

Pa tie nt C ha ra c te ristic s Enviro m e nt O the r Pe o p le C urre nt Tre a tm e ntExp e rie nc e

O utc o m e o f M e rit

Distra c tio n

Distra c tio n

Distraction appears to be the single greatest contributor to be “Hopeful for next treatment”

Private room perks had no positive contribution.

THE POWER OF DISTRACTION



PATIENT TO PATIENT INTERACTION

Location Summary







EMOTIONAL SUPPORT

?

Emotional Support



INDIANA UNIVERSITY SIMON CANCER CENTER
















Open Bays for patientand guest interaction

Roof top garden

Fireplace lounge area

Private Rooms

Nurse work station

Shelled

Shelled









Preliminary Site Observations

• Fireplace area is not used by patients, guests use for respite and sleep

• Staff work mostly at the nurse station, not in the workroom

• Open bays are more private than expected, the counter and casework screens

• Many patients and guests access the nourishment area

• New distractions:

iPods, Cell Phones, Digital Book Readers





Did we create too much privacy?

The importance of staff visibility



Next Steps

Post Occupancy: Three part follow-up study, examining the design criteria

• On-Site Observations, completed in May, 2010

• Staff Questionnaires, May-July, 2010

• Patient and Guest Questionnaires, May-July, 2010

Analyze the data

Present the findings




A N I D E A S B A S E D P R A C T I C E


Infusion of EvidenceThe journey will continue……

Documents

Research-informed Design of the Simon Cancer Center