Private Rooms, Semi-Open Areas, or Open Areas for Chemotherapy Care: Perspectives of Cancer Patients, Families, and Nursing Staff

Design of a Cancer Infusion Center: Results from a Pre- and Post-Occupancy Evaluation

PURPOSE

The current study performed a post-occupancy evaluation on a new cancer infusion center with pod-like layout and compared results to a pre-occupancy evaluation to investigate the impact of different cancer infusion center designs on staff efficiency and patient and staff satisfaction.

BACKGROUND

The new cancer infusion center opened in October 2020 and replaced two previously existing infusion centers, in the same healthcare system.

METHODS

The study used a similar mixed-method approach as the pre-occupancy research, which included staff shadowing, medication delivery shadowing, and staff and patient questionnaires.

RESULTS

The new infusion center improved staff efficiencies by reducing nurse travel time compared to pre-occupancy infusion centers. Results also showed an increase in satisfaction with different aspects of the new infusion center including patient privacy, by both patients and nurses. The pod design allowed for better audio and visual privacy for patients, provided a higher amount of worksurface and availability of workstations, reduced noise levels, and enhanced nurse concentration at workstations. Findings indicated that nurses who had prior experience working in the pre-occupancy infusion centers expressed significantly lower levels of satisfaction in the new infusion center, especially in the ability to connect with nurses in other pods.

CONCLUSIONS

Although the new pod design had limitations in terms of collaborative opportunities across pods, it showed to provide a more efficient work environment for the staff and increase staff and patient satisfactions. The results also highlight the importance of effective change management strategies when nurses transition to a new work environment.

Seeking Common Ground: A Grounded Theory of the Nurse-Patient Relationship in Cancer Infusion Care

BACKGROUND

The nurse-patient relationship represents a valuable connection in cancer care. Largely studied within inpatient settings, the nature and influence of this central relationship in ambulatory settings remain relatively unexamined. The notable shift to ambulatory settings like infusion centers warrants examination of the nurse-patient relationship in this context.

OBJECTIVE

The aim of this study was to develop a grounded theory of the nurse-patient relationship in ambulatory cancer infusion care.

INTERVENTIONS/METHODS

Using grounded theory methodology, 11 nurses were interviewed using a semistructured interview guide. Data collection continued until data saturation occurred with the primary concepts.

RESULTS

The grounded theory, entitled Seeking Common Ground, includes 6 primary concepts. The concepts "we are all human"; "we work in a busy, complex environment"; "we seek common ground with patients"; "we use connections to support meaningful encounters"; "we find meaning in the relationships created"; and "we are governed by the push and pull of time" abstract the nurse-patient relationship from the nurses' perspective, emphasizing fundamental human connections.

CONCLUSIONS

The grounded theory Seeking Common Ground depicts the profound connection that nurses form with their patients in the ambulatory infusion setting. Underscoring the value of the nurse-patient relationship as foundational to the nursing profession must be driven through practice, education, and policy.

IMPLICATIONS FOR PRACTICE

Consideration of educational aspects within nursing across all levels to influence clinical practice will remain key.

Gender and Patient Satisfaction in a Veterans Health Administration Outpatient Chemotherapy Unit

BACKGROUND

Our objective was to explore whether differences in patient satisfaction based on gender exist at the Veterans Affairs Portland Health Care System (VAPHCS) outpatient chemotherapy infusion unit.

METHODS

Veterans who received outpatient infusion treatments at the VAPHCS outpatient chemotherapy infusion unit from 2018 to 2020 were invited to take an anonymous survey. Response differences were analyzed using Fisher exact and Welch t tests. Male and female patient lists were first generated based on Computerized Patient Record System designation, then defined and results reported based on gender self-identification from survey responses.

RESULTS

The survey was conducted over a 2-week period during January and February of 2021. In total, 69 veterans were contacted: 21 (70%) of 30 female and 20 (51%) of 39 male veterans completed the survey. Most (62%) female patients were aged < 65 years, and 52% were treated for breast cancer. Most (90%) male patients were aged ≥ 65 years, and most commonly treated for prostate cancer (20%) or a hematologic malignancy (20%). Using our survey, patient satisfaction (SD) was 8.7 (2.2) on a 10-point scale among women, and 9.6 (0.6) among men (P = .11). History of sexual abuse or harassment was reported by 86% of women compared with 10% of men (P < .001). Women reported feeling uncomfortable around other patients in the infusion unit compared with men (29% vs 0%; P = .02) and discomfort in relaying uncomfortable feelings to a clinician (29% vs 0%; P = .02).

CONCLUSIONS

Gender seems to be related to how veterans with cancer perceive their ambulatory cancer care. This may be due to the combination of a high history of sexual abuse and/or harassment among women who represent a minority of the total infusion unit population, the majority of whom receive treatment for a primarily gender-specific breast malignancy. Analysis was limited by the small sample size of women, many with advanced malignancy.

Influences of Physical Layout and Space on Patient Safety and Communication in Ambulatory Oncology Practices: A Multisite, Mixed Method Investigation

OBJECTIVE

To examine how physical layouts and space in ambulatory oncology practices influence patient safety and clinician communication.

BACKGROUND

Ambulatory oncology practices face unique challenges in delivering safe care. With increasing patient volumes, these settings require additional attention to support patient safety and efficient clinical work processes.

METHODS

This study used a mixed methods design with sequential data collection. Eight ambulatory oncology practices (of 29 participating practices) participated in both the quantitative and qualitative phases. In surveys, clinicians (n = 56) reported on safety organizing and communication satisfaction measures. Qualitative data included observations and semistructured interviews (n = 46) with insight into how physical layout influenced care delivery. Quantitative analysis of survey data included descriptive and correlational statistics. Qualitative analysis used inductive and thematic content analysis. Quantitative and qualitative data were integrated using side-by-side comparison tables for thematic analysis.

RESULTS

Safety organizing performance was positively correlated with clinician communication satisfaction, r(54 df) = .414, p = .002. Qualitative analyses affirmed that the physical layout affected communication around chemotherapy infusion and ultimately patient safety. After data integration, safety organizing and clinician communication were represented by two themes: visibility of patients during infusion and the proximity of clinicians in the infusion center to clinicians in the clinic where providers see patients.

CONCLUSIONS

Physical layouts of ambulatory oncology practices are an important factor to promote patient safety. Our findings inform efforts to construct new and modify existing infusion centers to enhance patient safety and clinician communication.

Experiences of Outpatient Clinics and Opinions of Telehealth by Caucasian and South Asian Patients' With Celiac Disease

Outpatient clinics are an important part of chronic disease management, including that of celiac disease. During the coronavirus disease 2019 (COVID-19) global pandemic, telephone and online video consultations with health care professionals have substantially increased. This study aimed to explore the experience and opinions of adults, with celiac disease, toward face-to-face clinic appointments and alternatives, such as telehealth. Semistructured qualitative interviews with 37 patients were undertaken (75% White Caucasians, 25% South Asians; 29 patients were not adhering to the gluten-free diet). Interviews were recorded, transcribed, and analyzed by NVivo. Frequently reported issues with face-to-face appointments included travel and car parking costs, needing to take time off work, and frequent changes to appointment time. In addition, South Asian patients highlighted issues with linguistics barriers. Telephone consultations were considered acceptable and practical by the majority of patients based on ease and convenience. Online video consultations were favored by just 9 patients, however it is acknowledged that since the COVID-19 pandemic, there has been a greater exposure to this type of technology. These patient experiences can inform health care service development and are not biased by external health concerns connected with in-person visits during the pandemic.

Respect for Autonomy: Seeking the Roles of Healthcare Design From the Principle of Biomedical Ethics

OBJECTIVE

This article aims to discuss the role of the healthcare environment on patient's autonomy. Referring to biomedical ethics will provide a research logic and form a theoretical framework for healthcare designers to define patient autonomy, to master the conditions for promoting it, and to discover the potential of the environment.

BACKGROUND

In modern society, it becomes the responsibility of healthcare architects to realize the design of "benefit for patients." The goal of healthcare environment design and research is also gradually from a basic level of ensuring the physiological safety of patients to achieving a higher level of respecting patients and helping realize their self-realization. However, how to express respect to patients in the healthcare environment is ambiguous. In order to break through the limitation of architectural specialty, we propose to introduce biomedical ethics. Under this major premise, this article will discuss from the perspective of respect for autonomy (RA).

METHOD

This article combines the definition of autonomy and the discussion of the medical and nursing practice to summarize and propose the themes about RA. It draws on the top-down deductive logic of biomedical ethics from theory to application and applies the three-condition theory of Beauchamp and Childress to deduce the role of the healthcare environment on patient autonomy in each theme.

CONCLUSION

Introducing biomedical ethics into the study of environmental design provides a more theoretical and systematic way of thinking about the role of the healthcare environment. Some autonomy-supportive design strategies are collected and proposed.

Using Evidence to Design Cancer Care Facilities

The nuts and bolts of planning and designing cancer care facilities—the physical space, the social systems, the clinical and nonclinical workflows, and all of the patient-facing services—directly influence the quality of clinical care and the overall patient experience. Cancer facilities should be conceived and constructed on the basis of evidence-based design thinking and implementation, complemented by input from key stakeholders such as patients, families, and clinicians. Specifically, facilities should be designed to improve the patient experience, offer options for urgent care, maximize infection control, support and streamline the work of multidisciplinary teams, integrate research and teaching, incorporate palliative care, and look beyond mere diagnosis and treatment to patient wellness—all tailored to each cancer center’s patient population and logistical and financial constraints. From conception to completion to iterative reevaluation, motivated institutions can learn to make their own facilities reflect the excellence in cancer care that they aim to deliver to patients.

The Impact of Infusion Center Layout on Workflow and Satisfactions in Two Cancer Infusion Centers: A Case Study on Staff and Patients

OBJECTIVE

The objective of this empirical research is to compare nurses' operational workflow and nurses' and patients' satisfactions of two different infusion center designs. One center has a traditional open bay design and the other has semi-private bays. This study also intends to gather baseline data to compare to a future post-occupancy evaluation of a new infusion center where the two existing centers will be combined.

BACKGROUND

The increasing number of patients with cancer diagnosis who refer to infusion centers highlights the importance of design of these centers.

METHOD

The mixed-method approach of this study involves shadowing nurses and surveying nurses and patients. Data collection captured nurses' activities, activity durations, and nurses' and patients' satisfaction with the design of clinics.

RESULTS

Comparison of shadowing data indicated that although the infusion centers have different layouts, there are no significant differences in the activities or time spent by nurses in different areas among the centers. Staff, however, have different satisfaction levels with visual and speech privacy, ability to concentrate without distraction, collaboration with other staff, and the process of medication delivery. Patients also had slightly different satisfaction levels with their ability to communicate with staff and design of bays.

CONCLUSION

This research sheds light on operational workflows and satisfaction of staff and patients in two different infusion center design. Considering the limited studies on these settings, this study serves as baseline data to compare to other studies on cancer infusion centers and addresses issues of benchmarking and staff and patient satisfaction.