Exploring the Physical Environments Surrounding Cancer Care
Week 04 | February 6–12, 2024
This week we have transitioned from understanding and framing the design problem into exploratory research. Ultimately, over the next two weeks we want to create some well-informed research objectives.
Class on Tuesday and Thursday were not required. We used the time to coordinate with our CARE champions and to meet them for a site tour of the hospital. We met Thursday afternoon, during class time.
This post builds off of our Questions Informing our Research post.
Exploring the Topic
Tuesday’s class was not required in person. One group member attended and used class time to explore the topic prompt with a mind map.
The exploration started with the chemo binder and listing out its qualities: the current state.
It then moved into the idea of the binder being more of a conversational guide. This connected back to the most referenced metaphor so far, the cancer journey. Much like conversation, the cancer journey is nonlinear and is not singular: there are forks in the path where those with cancer have agency to make choices. How can we bring this to light?
Given the connections to journeys, guides, and [conversational] paths, the sherpa seemed an apt connection. Sherpas have been in a place before, and are helpful and supportive guides throughout your journey.
Then, deeper connections started to surface. It’s important to clearly communicate the information in a way that’s easy to understand, but it’s also important that we are supporting people emotionally and helping them to feel safe.
It’s crucial that we communicate information in a way that engenders trust. Whose voice do we want to hear and trust for different types of information: a doctor? a friend? someone who has gone through chemo? Do they want strictly information? A story? Connection?
Is there a way to engage people in a way that helps them to see themselves in the process? Might this also be helpful for those who are anxious for a diagnosis or have just received their treatment plan?
Exploring the Physical Environment
For Thursday, we coordinated with our CARE champions so that they could show us some of the physical spaces involved with gynecological oncology treatments. We met in the lobby of UPMC Magee-Women’s Hospital, and while we were waiting for our full group to arrive, we were able to learn more about the problem space from the perspective of a healthcare worker:
- the process is much more chaotic and uncertain before arriving at UPMC’s gynonc department
- new patients do not have a diagnosis, but it is suspected
- every patient that receives the chemo binder has a diagnosis: they have (1) a treatment plan and (2) an established relationship with a gynonc physician
- they think the binder is not specific to gynonc, but UPMC based on the information listed but weren’t sure on the specifics
- there is no understanding of how often it is updated or who is responsible for that
- it is assumed that patients fill out the charts in the binder, though others (healthcare workers and patients) have claimed to never see the binder once it is given to patients
Gynecological Oncology
We spent the most time in the gynonc department and were able to explore this space in the most depth.
Upon entering the waiting room, there is a major shift in mood from the vast natural lighting and enormous verticality of UPMC Magee-Women’s atrium. The waiting room felt more enclosed, darker, and quiet despite the background noise from the television. We instinctively found ourselves talking sparingly and at a lower volume.
The seating of the waiting rooms was close and a little unnatural. You sat facing others across the room, but not those closest to you. This seating reinforces the feeling of not being able to talk or converse with those closest to you.
There was a collection of hand-made hats at the reception area, free for patients to take.
Moving past the waiting room and into the hallways of the department, we came to realize that there was somewhat of a symmetrical set-up for the department. Each side had doctors and medical assistants assigned. there were short hallways that joined on either side. Positioned in the middle, it was unclear whether other healthcare professionals, like advanced practice providers, were shared.
We briefly toured the exam room, in which patients and their caregivers interact the most with healthcare workers. This space is where new patients may receive a diagnosis or undergo a pelvic exam, meet for post-operative symptoms, or before chemo treatments.
We ended the gynonc department tour with the chemo treatment room. This room seemed to be a valuable resource. Like the binder, it attempts to bridge communication gaps. Importantly, it gives patients an opportunity to ask questions that are important for them on their journey. This is the space in which patients receive the chemo binder.
The cadence of this interaction is very important: patients receive information after they have the time and space to ask questions. How can we help them prepare for chemo teaching, rather than react to it?
Outpatient Laboratory Testing
It was a very short distance between gynonc and labs — just around a corner.
We received a cursory glance at the outpatient lab waiting room. The outpatient lab services all of Magee-Women’s Hospital. It is the first clinical area you notice upon entering the atrium.
On chemo days, patients can receive their lab before or after checking in at gynonc, but both must be done before receiving treatment. Alternatively, you may have labs done the day before at another hospital.
We were assured that lab work was fast.
Women’s Cancer
We ended in the waiting room for the women’s cancer department. This room felt more inviting and open to conversation than gynonc. You could tell that the hospital had the assumption that people might be here for a long time: there was a round table for activities, a small kitchenette with bottled water and snacks, a coat room, as well as the prototypical waiting room space.
As compared with gynonc, it felt lighter and more welcoming.
There was a Christmas tree in the corner with little decoration.
There was some wall art in the kitchenette, but it heavily represented breast cancer with the color pink. No other women’s cancers were represented in this space. (Around 80% of the patients that go through the Women’s Cancer department have breast cancer. However, the remaining 20% is still a significant amount of people to not be represented in that space.)
It is important for us to note that we visited at a time in which we saw little-to-no patients. We got a good understanding of the physical spaces and routes that patients may travel, but not of what patients themselves do or interact with while they are there. Additionally, since we were a group of five, there were too many of us to see the area in which chemotherapy treatments are administered. It was important that we did not disrupt patients.
Relating it back to the Binder
The binder could be seen as a tangible expression of the hospital’s care, converting the intangible support into a physical object. This object has the potential to offer comfort and support to patients.
Currently, the binder is underutilized, outdated, and not easily understood as an object of support. How can we, as designers, enhance or reimagine this object so that it provides ongoing support throughout the patient’s journey?
In its current state, the binder feels more like a tool that checks off boxes, rather than a form of communication between a patient and their healthcare providers.
It seems that the binder is given to patients too late in the process. Would it be better to provide patients with information before meeting for their chemo education so they can ask the right questions?
Quotes
T
“That having a plan is when it feels so great.”
“… Traveling that same path.”
Regarding the binder: “…Planting some seeds so that they know to use it as a resource.”
AM
“New patients don’t actually have a diagnosis.”
The work for this project comes from the Designing for CARE course, designed by Kristin Hughes for the School of Design, Carnegie Mellon University. This course is a collaboration between the School of Design and University of Pittsburgh Medical Center.
