By Erica Steele

As she lay in bed during her first night at Baylor University Medical Center in Dallas‚ Lori Krone gazed up and was pleasantly surprised to find not a standard white ceiling panel‚ but an illuminated landscape scene. Krone says the lighted picture of trees and flowers on a sunny day provided comfort that first night after her surgery. That‚ combined with the soft‚ warm colors of the wallpaper and the paintings on the walls‚ demonstrated to her that the hospital was going that extra distance to make patients feel more comfortable.“It really shows that they care‚” she said. Without that cold‚ impersonal atmosphere found in many facilities‚ she said it felt as close to home as possible.   

A New Focus on Healing
In recent years‚ healthcare facilities across the country have been creating more patient-friendly environments‚ including cancer treatment centers. From enhancing facility design with features like soothing artwork‚ to offering complementary therapy programs that promote patient wellness‚ awareness of the need to create environments that encourage healing has increased dramatically. “People are not one-dimensional. We are trying to help them get better on the whole‚” says Kathy Thomas Welch‚ social worker and co-chair of the Baylor University Medical Center’s Healing Environments program. Baylor is one of many institutions nationwide with programs seeking to enhance patient wellness through stress reduction. The program started in 1997 in the oncology section and has since expanded throughout the hospital. A 24-hour relaxation channel plays soothing music to accompany serene pictures‚ large aquariums located in high-stress areas of the hospital such as ICU waiting rooms provide a relaxing distraction‚ and visiting clowns and musicians volunteer their time to lift the spirits of patients and their families.
 
Light, Color, and Quiet
The new Harry and Jeanette Weinberg Building at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins was designed with healing in mind. It incorporates soft colors‚ natural light‚ and gallery-quality artwork with a music program to create a less stressful atmosphere for patients. “We wanted to create an environment that’s as peaceful‚ hopeful‚ and comfortable as possible‚” says Martin D. Abeloff‚ MD‚ the cancer center director. He says that in addition to providing the best treatment possible‚ it is important to offer patients and their families a soothing atmosphere to enhance the healing process.

“Healthcare providers are learning that good design can benefit everyone‚” says Roger Ulrich‚ PhD‚ director of the Texas A&M University Center for Health Systems and Design. In his research‚ Dr. Ulrich has found that hospitals can alleviate some of the stress experienced by patients through supportive‚ evidence-based design. For example‚ noise in hospitals is not just annoying to many patients‚ but is often detrimental to their sleep quality. A 1996 study in Sleep (the journal of the American Academy of Sleep Medicine and the Sleep Research Society) found that patients staying in an intermediate respiratory care unit likely experienced some sleep disruption due to the environmental noise‚ which peaked at 80 A-weighted decibels. Dr. Ulrich suggests that creating rooms with sound-absorbing elements‚ and also utilizing silent paging systems for the staff‚ will help decrease noise level. Patients staying in single rooms consistently report higher rates of satisfaction overall‚ he says‚ due in part to the more private‚ quieter environment in which they can communicate with staff and family members more openly. He also notes the importance of having positive distractions that promote relaxation‚ such as windows with nature views‚ gardens‚ music programs‚ and soothing artwork on the walls.
“When patients are externally distracted in a pleasant way‚ their perception of pain is affected‚ and they tend to report experiencing less pain‚” Dr. Ulrich says.

Creating a Visual Environment
Dr. Ulrich took part in a 1993 study of 160 heart surgery patients in a Swedish hospital that found viewing a serene landscape painting can benefit patients during recovery‚ while viewing a confusing abstract painting can be detrimental. The researchers found that patients whose rooms were randomly assigned a nature painting of a tree and calm water had better overall recovery and required fewer doses of strong pain medication. Another landscape scene of a shady forest had no notable positive or negative effects‚ while patients with an abstract painting responded negatively‚ and some asked for it to be removed. Besides pictures of sunny‚ open landscapes‚ Dr. Ulrich has found figurative pictures of people with clearly positive facial expressions‚ especially pictures of women or children‚ to be advantageous to patients.

“The worst thing you can do is to have a patient who is waiting for chemotherapy staring at fluorescent lights and white walls. This can only add to the stress they’re already experiencing‚” he says.

Dr. Ulrich suggests that supportive‚ healing-conducive design can be beneficial and even cost effective in the long run. The stress experienced by patients and their families‚ and also by healthcare staff‚ can be combated through healing design‚ comfortable waiting rooms for families‚ break rooms for staff‚ and gardens for everyone to relax in and enjoy. By providing positive distractions and fostering a sense of privacy in design‚ while still allowing access to social support‚ healthcare facilities can enhance their overall quality of care.

More Than Space
In addition to physically improving their facilities‚ many institutions are also offering complementary therapy programs to manage symptoms and enhance the patient’s overall wellness. In a 1999 National Cancer Institute survey of 26 NCI-designated cancer centers‚ 54% had Complementary and Alternative Medicine (CAM) programs and 88% had staff members dedicated to CAM. National Institutes of Health created the Center for Complementary and Alternative Medicine‚ and is currently funding studies of various CAM therapies to determine their benefits.

The Integrative Medicine Service of the Memorial Sloan-Kettering Cancer Center (MSKCC) has grown rapidly since its creation three years ago‚ says Barrie R. Cassileth‚ PhD‚ chief of Integrative Medicine. With a 50-person staff and variety of in- and outpatient services‚ they work to improve the quality of life for cancer patients‚ and to educate patients and healthcare providers about integrative medicine. Dr. Cassileth‚ author of The Alternative Medicine Handbook: The Complete Reference Guide to Alternative and Complementary Therapies‚ views complementary therapy as a modern extension of supportive care‚ which for so many years consisted mainly of chaplaincy and support groups.

Classes held in the relaxing outpatient center such as Tai Chi and meditation are selected carefully for their benefits to cancer patients‚ who come from MSKCC and elsewhere to participate. The individual therapies offered to patients at MSKCC‚ like massage and music therapy‚ are also chosen for their positive effects. Dr. Cassileth stresses that only therapies with some data supporting their benefits are offered. Anecdotal reports from patients indicate that many of these therapies are indeed beneficial.

Yet more studies are needed to bring integrative medicine into the mainstream medical world‚ Dr. Cassileth adds‚ which is why the Integrative Medicine Service conducts research to determine the effects of various complementary therapies on cancer patients. These studies include acupuncture to treat hot flashes in breast and prostate cancer patients‚ and music therapy to relax patients awaiting bone marrow transplants.

Dr. Cassileth‚ who has studied complementary and alternative medicine use among cancer patients for many years‚ stresses the importance of distinguishing between the two terms. Alternative therapies are often just that alternatives to clinical treatment‚ which can be unproven and potentially dangerous‚ she says. Complementary therapies‚ however‚ when used in conjunction with regular treatment‚ can truly benefit the patient. “Many patients tell us that they could not have gotten through their cancer treatments without us.”

M. D. Anderson Cancer Center’s Place of Wellness in Houston‚ Texas‚ also provides complementary therapies to current and recovering cancer patients‚ along with their friends and families. Opened in 1998‚ the Place of Wellness now offers 75 to 100 programs‚ with a total of 500 to 700 participants per month‚ says Deanna Cuello‚ special programs coordinator.

“We understand that between all the appointments and treatments‚ there isn’t much time for patients to have for themselves. Our programs are designed for patients to come and participate in as they are able‚” she says.

The programs include self-hypnosis and relaxation for symptoms‚ stress management techniques‚ and yoga (no extreme forms are done). They also provide various support groups and educational programs. Complementary therapy is an important addition to clinical treatment‚ Cuello says. “As a cancer patient‚ you have so much done to you that you lose your sense of self-control. Here patients are given a chance to regain some of that sense of control‚ and reconnect with themselves.”