The Center For Health Design
Why does this study matter?
In recent years, the design of spaces for chemotherapy treatment has shifted from private rooms and open-units in inpatient settings, to semi-open areas in outpatient care centers. Despite the shift towards ambulatory care, the majority of evidence-based design research in this area is still focused on the inpatient setting.
The Facility Guidelines Institute (FGI) (2010 and 2014) recommends that cancer chemotherapy treatment can be in an open or shared area, and that the ratio of open and private bays/cubicles/rooms should depend on the various needs and level of care required for the particular patient population. Current best practice in this area of design suggests that we want to give patients the option for some level of privacy through privacy curtains or retractable screens, while also offering the chance to interact with other patients while being monitored by nursing staff. Treatment sessions can last up to eight hours, and patients may engage in a several different activities during that time. But do we really know what patients need and want during their treatment? What type of treatment space is best suited to meet their needs? And what do staff think?
How was the study done?
The study focused on two research questions:
The researchers collected data from 171 cancer patients, 145 family members, and 16 nursing staff at a cancer center in Louisiana using a questionnaire. The questionnaire asked participants to indicate their preference for a private room, semi-private area, or open treatment area.
Researchers gave patients and their families the questionnaire during their treatment which was taking place in one of the three types of environments. Nurses filled out the questionnaire in a survey meeting.
So what do we learn from the study?
The results of the study showed that most staff (more than 80%) preferred semi-open areas. However, each of the three environments (private rooms; semi-open areas; and open areas) were equally popular among patients and families (30%, 27%, and 35%, respectively).
Women and patients who were there for longer treatments liked private rooms more than other patients did. Patients and staff wrote about privacy, social interaction, and patient-nurse access when explaining the reason behind their preferred choices. They also mentioned access to the toilet and daylight (or window views).
On average, patients suggested about five patients would be appropriate per treatment area. Staff suggested a slightly higher average number: 6.5 patients per treatment area.
Can we say the results are definitive?
This study gives us a high-level view of what patients, families, and staff may want in an outpatient chemotherapy treatment space. However, as the authors admit, this study took place at only one cancer center and can’t be interpreted as “one size fits all”.
The patient preferences reported in this study are a good starting point, but need further investigation. More than 70% of patients and family members chose the type of space they were currently in during the survey as their preferred environment. It is difficult to know if their selections were based on their actual preference, or more about specific things they liked about their current experience. For instance, patients and families who preferred open areas explained their selection with key words such as “window views” or “daylight”. One comment in particular was “open areas are usually sunny. We enjoy the outside view and not being secluded.” As the authors suggest, if a private room has daylight, perhaps patients and families who originally selected open areas would have chosen private areas.
While the study gives some helpful information for designers trying to understand the preferences and needs of cancer patients receiving chemotherapy and their family members, there are limitations to the findings that should be explored. Patients undergoing chemotherapy are frequently immunosuppressed, and future studies should examine a balance between social needs and infection control issues in these multi-patient areas.
What’s the takeaway?
Designers should consider spaces that provide options for privacy, social interaction, and access to nurses, and views of nature. The number of patients (or treatment pods) per treatment area depends on several constraints set in each project, but designers can refer to the suggestions made in this study (5 to 6.5 patients) as a jumping off point for discussion.
FGI (2014) recommends that the size of the treatment area and ratio of open patient care stations and private bays/cubicles/rooms should depend on the patient acuity mix and planned use of the unit, and that at least one private treatment room is recommended. This study supports the guideline, showing that a mix of treatment spaces can support the various needs and preferences patients, families, and staff may have. Patient and staff needs are likely to vary from day to day and project to project, and flexibility in treatment area types can support this.
While the minimum standards provided by FGI and current best practices are a great starting point, many organizations will want to go above and beyond in providing the best possible environment for their patients. This study attempts to find out what “the best” might include.
Wang, Z., & Pukszta, M. (2018). Private Rooms, Semi-Open Areas, or Open Areas for Chemotherapy Care: Perspectives of Cancer Patients, Families, and Nursing Staff. HERD: Health Environments Research & Design Journal, 11(3), 94–108. https://doi.org/10.1177/1937586718758445
Our slidecasts are an outcome of the popular Research Matters presentations at the annual Healthcare Design Expo & Conference. Our research team picks papers that have some significance to the healthcare design community and distill the study down into a 5-minute summary of how the study was done, what was learned, the limitations and the takeaway. The slidecasts bring research to you in digestible format. Just five minutes, and you’ll know more.
As a part of The Center's research team, Melissa focuses her efforts on grant-funded research initiatives, as well as supporting ongoing work of The Center, such as the Affiliate+ program, the Knowledge Repository, and the Evidence Based Design Accreditation and Certification (EDAC) program. She examines the impact of the built environment on health through the development of conceptual models that link design and outcomes and by evaluating the effects of evidence-based design innovations and by disseminating research findings through tools, presentations, and publications.
Melissa was previously a senior design researcher for Davis Partnership Architects and prior to that she served as a researcher with the OMNI Institute and the Center for Children, Youth & Environments at the University of Colorado. With a background in both architecture and social science, Melissa describes her research style as “boots on the ground with a knack for rigor.”
Melissa graduated from Cornell University with a Masters of Science, Applied Research in Environmental Psychology and received her Bachelors of Environmental Design, Emphasis in Architecture from University of Colorado, Boulder.