Help create a healing environment in cancer hospital to facilitate the cancer patients recover

Analyse the architecture design how to help create a healing environment in cancer hospital to facilitate the cancer patients recover

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STUDENT ID Wenjing Ma:18010710 Dissertation Submitted to the Manchester School of Architecture Master of Architecture Manchester School of Architecture University of Manchester Metropolitan University August 12, 2020 Supervised by: Dr. Luciana Lang <L.Lang@mmu.ac.uk>

CONTENT Abstract Introduction Chapter 1 Review of literature on the healing environments design and cancer treatment 1.1 Review of literature on theories of healing environment 1.2 Review of literature on physical phenomena in healing architectural design 1.3 Review of literature on physical features in the healing environment of cancer hospital Chapter 2 Research questions 2.1 What are the principles underlying the healing mechanism in the context of cancer rehabilitation?

2.2How can those principles influence the work by architects when designing a healing environment 2.3 Summary list 2.4 Assessment of the potential impact of the Cancer Hospital Design factors on healing of cancer patients Chapter 3 Case study on Maggie's Cancer Caring Centre 3.1 Case study on Maggie's Cancer Caring Centre, Manchester 3.2 Case Study on different architectural Spaces of Maggieâ&#x20AC;&#x2122;s Cancer Caring Centre Conclusion References

KEYWORDS Cancer hospital architecture design; hospital space; multi-sensory design; evidence-based design; Healing environment ;healing architecture; healing landscape, Quantum mechanics; symbiotic systems; Cancer patients ; health care; well-being;

ABSTRACT I used to have a fair amount of contact and interaction with cancer patients, so I am well aware of their situation. The time they spend in hospital when subject to both physical pains and mental stress may be the last time in their life. As an architect, I have also worked in an architectural academy that specializes in the design of medical buildings. For such experience, I cast doubt on the design of conventional medical buildings. To be specific, the mechanical and compact design can pose psychological pressure to cancer patients and their family in the rehabilitation period, which can cause the recurrence and deterioration of the illness of cancer patients. All the mentioned experiences have kept making me explore the role that I can play in the treatment and rescue of cancer patients. Moreover, I consider the core of design as the connection between space and its usersâ&#x20AC;&#x2122; feelings. In other words, even if we are gaining increasing skills and technologies to create a space, that we should keep in mind why we build the space in the first place is of critical importance. On that basis, this dissertation investigates intentionality versus experience and aims to answer the question that to what extent do architectural design creates a healing environment in cancer hospitals to facilitate the recovery of cancer patients.

For this aim, several research methods are employed here to study the physical features in the rehabilitation environment of cancer patients and determine the optimal improvements that can be made in the space to help patients recover physically, socially and psychologically.

First, I present and explain the history and theories of healing environment, in which physical features in healing architectural design are of high importance. Such physical features can be classified into ambient features, architectural features, decoration features and facility features. Next, their relationships are described and explained, as supplemented with self-authored retrospective diagrams. I also analyse the mentioned features regarding the theories above. Then, I explain how to build a healing environment in cancer hospital to benefit the cancer patients. By drawing a comparison in the form of the summary list, I seek to demonstrate the vital points that should be considered in the design of vital space in a hospital. Lastly, in the case study section, several cases are listed to demonstrate my point, i.e., how the design and control of the mentioned four physical features can help create a desirable healing environment.

The present dissertation concludes that the healing environment in medical buildings is interconnected with the rehabilitation of cancer patients. Such a healing environment can be established by designing vital physical features, which will elevate the survival rate and lower the recurrence rate of cancer patients.

INTRODUCTION In 2012, I spent a long period in cancer hospitals to take care of my family. I stayed in three different cancer hospitals in that period, and I could feel the psychological pressure when first entered each of them. Such pressure was posed by the crowded corridors, the smell of drugs everywhere, and the grave look on the faces of patients when they were looking outside the window. I saw many patients wake up in the mid-night because of pains and spend a lonely night awake. They had to face the pain and resist the fear and pressure alone. These pictures touched me deeply and made me think whether the design of medical buildings can impact the healing of patients as a supplement of drugs and medical treatment.

In 2015, when designing hospitals during my working experience in a design academy, I became increasingly aware of and intrigued by the significant connection between the architectural design of a hospital and its users. I found that the typical and common design method in China is to set up a visually attractive design and subsequently work on the fulfilment and construction of the design. In other words, the special design of architects focusing simply on the visual effects is short-sighted, since they fail to consider the multi-purpose experiences of users in their stay in the space or buildings. Such experiences cannot be sensed in the design draft, but should be sensed in the real physical features of a hospital. Thus, I seek to make some breakthrough in this field.

Furthermore, I began to study the cases of some excellent cancer hospitals, and the case of Maggie's cancer caring centres aroused my attention. The centre is named after Maggie Keswick, who died of cancer.

Her husband, Charles Jencks, was a well-known architect and critic(Our story, 2020). They both believed in the power of architecture, which can inspire and positively impact the rehabilitation of patients (Jencks, 2017). Maggie's cancer caring centre refers to a pioneer and model in cancer caring architectural design (Jencks and Heathcote, 2010). Under the increasingly sophisticated chemical and instrumental treatment, the therapeutic value of environment and the positive effects of closeness to nature have been overlooked.

However, I am inclined to believe that the healing effects of environment in treatment and rehabilitation should be stressed. For one thing, since cancer is a chronic disease, the life quality of advanced cancer patients should be highlighted and ensured. In this case, the positive effects of healing environment bring more comfort than those of chemical and medical instrument, which often go together with great pains.

For instance, the chemical radioactive treatment also kills the immune cells of cancer patients when it can kill cancer cells. For another, considerable evidences have shown that rehabilitation results of many patients with similar physical conditions can be quite different. Those close to natural environment tend to have lower rate of recurrence and mortality, which is why constructing a healing environment should be stressed.

However, upon further research I identified a gap in the relevant literature. Methodology, techniques and plans for architectural design are popular, whereas psychology, behaviours, laws and institutions have been rarely studied, indicating that studies on physical and psychological aspects of space design are necessary. I consider a disjuncture existing between Architectâ&#x20AC;&#x2122;s Intentionality versus actual cancer patientsâ&#x20AC;&#x2122; Experience.

Thus, this dissertation aims to answer the question that to what extent can the work of architect create a positive healing environment to expedite the rehabilitation of cancer patients. This question is considered from my personal perspective to be highly important. Moreover, it is necessary for architects to understand the uniqueness of cancer hospitals, so they can combine their design with the specific requirements of cancer patients. thereby enhancing the value of their design.

For the aim of this dissertation, I have completed three objectives. Chapter 1 contextualises the three major themes of my dissertation. First, the history and variety of approaches of healing environment are

presented and explained. According to theories, the designing healing environment design of cancer hospitals is classified here into 4 physical features, i.e., ambient features, architectural features, decoration features and facility features. As I will later explain, this classification is significant as different physical features significantly alter architects’ intentionality, and then user experience. (Chapter 1). Next, I describe and explain two complimentary theories regarding the way by which we experience space. One is from cancers patient experience to analyse the principles of healing mechanism between healing environment and cancer rehabilitation. Another is from architects’ intentionality to discuss how to shape healing environments in cancer hospital from five different types of space design under the types of four physical features. In brief, my points are categorised into a comparison table, considering what are the positive factors, and they are listed in the order of importance.(Chapter 2). Lastly, I study the case on Maggie Cancer Rehabilitation centre, which are the successful design of cancer care centre. Besides, I collected design concepts of excellent architects and the feedback of cancer patients' memories on the impression and feeling of the physical environment of the hospital. For this end, I searched primary data from the website and research of Maggie Cancer Rehabilitation Centre, as supplemented by additional photographs, plans and the analysis diagram drawn by myself. Subsequently, I analyse Chapter 3 the mentioned cases according to the theories above of Chapter 1 and chapter2. (Chapter 3).

Though some people argue that treatment based on chemical and medical equipment are effective, I argue a fact that the therapeutic value of environment and the positive effects of closeness to nature have been ignored. I am inclined to believe that the healing effects of environment in treatment and rehabilitation should be stressed more than treatment equipment. For one thing, according to Schweitzer et al.

(2004), the positive effects of healing environment bring more comfort than those of chemical and medical equipment. Castello et al. (2010) suggested that ‘cancer is a chronic disease’, and the life quality of advanced cancer patients should be ensured. However, the chemical and instrumental treatment often go together with great pains. For instance, the chemical radioactive treatment also kills the immune cells of cancer patients when capable of killing cancer cells. For another, it is considerably evidenced that rehabilitation results of many patients with similar physical conditions can be significantly different. Tate (2002) carried out the a survey data from quality of life of cancer patients on 2019 that those close to natural environment tended to have lower rate of recurrence and mortality, which explains why constructing a healing environment should be given importance.

This dissertation draws the conclusion that the healing environment in medical buildings is interconnected with the rehabilitation of cancer patients. Such a healing environment can be established by designing key physical features, which will increase the survival rate and down-regulate the recurrence rate of cancer patients.

CHAPTER 1 Review of literature on the healing environments design and cancer treatment 1.1 Review of literature on theory origin of healing environment As fuelled by the ceaseless development of medical technology, the idea that healing environment can facilitate the recovery of patients has been identified and studied repeatedly. As stated by Dominiczak(2014), ancient people have realised the healing effects of environment. For example, as early

as Ancient Athens, the temple that worshiped Ascleios, the medicine god, acted as a place for recovery. Patients travelled long distance to the front of the temple. They fasted, offered sacrifices and soaked their body in the sacred spring to cleanse their sins. In the medieval period, some clergy provided medical treatment and mental comfort to disciples with illness in the monastery. Patents settled down in the wards nearby, in which they could watch or hear prayers. Moreover, ancient Chinese were willing to visit and settle down near temples surrounded by mountains and rivers. Such places were far from the bustling cities, so they were significantly conducive to patients. Between the second half of the 19th century and the early 20th century, Nightingale, the nurse and statistician, considered that specifications should be required for hospital building in terms of size, windows, ventilation, heating, building materials and colours Dominiczak(2014). She also proposed that pavilion-style hospitals should be built to ensure the rationality and reduce mortality. She developed the notion that many factors in the environment impact the recovery of patients based on her observance and statistics Dominiczak(2014). In the history, hospitals originated from industrialization; they were initially built to treat wounded soldiers after wars (Zhanglinzi,2015). As medical science has been leaping forward, however, rationality and efficiency were considered the core of the design of medical facilities. For instance, high-rise hospitals were built everywhere, with natural wind replaced by air-conditioners and outdoor natural environment replaced by car parks. Furthermore, the domestic design of a hospital has become compact, making it more like a ‘machine’. In brief, people seem to have forgotten the healing effects of surroundings and the closeness to nature.

The adverse effect of such single, exclusive medical treatment has emerged, which has aroused new interest in the study on the healing effects of environment, or surroundings. George Libman Engel (1977), an American internist and psychiatrist, proposed to introduce a novel mode, i.e., biology, psychology and society. Besides, Ulrich (1984) reported that the recovery of those patients who can see the natural scenes through windows were significantly better than those who could see the walls of hospitals only. As revealed from the findings, unfavourable surroundings may cause mental stress for patients and inhibit their recovery. Stephen Kaplan (1989) is a psychology professor in University of Michigan. His work on ‘healing environment’ and attention recovery has inspired the work of professional landscape designers and the way people look at the relation between humans and nature. He reported that over-attention to anything may cause mental tiredness, which can be remedied by closeness to nature. Thus, to fulfil the relaxing effects of nature, an environment that attracts patients is of vital importance. The theories proposed by Ulrich and the Kaplans inspired the emerging studies on the healing environment and offered solid support.

By the 1970s, the ‘Planetree’ movement initiated a novel trend to design medical environment by complying with the needs of patients, as well as the ‘Art-cart’ movement combined medical environment with arts in the early 1990s, which had been well received. The success of all the mentioned movements increases the necessity of improvement and renovation of medical environment. Besides, the significant role that healing environment plays in the recovery of patients have been realised at a large scale. In the early 1990s, an evaluation study was conducted on the medical environment in four American hospitals. The researchers studied the hospital gardens in different ways (e.g., perspective analysis and interviews with patients). Most users interviewed suggested that the gardens helped them relieve their stress and, to some extent, facilitated their recovery (Marcus and Barnes,1999). The mentioned study quantified the effects of a healing environment on patients’ feelings and behaviours. Even more evidence has shown that a favourable environment can optimize and supplement medical treatment. An English scholar, Berg (2005) reviewed the study on healing environment and highlighted that closeness to nature, sufficient sunshine, fresh air, and peaceful environment, considered as four critical environmental factors, could be expanded and employed in all medical structures. Since the introduction of the concept of healing environment, relevant theories have been continually expanded and specialized.

1.2 Review of literature on physical phenomena in healing architectural design Miller et al., (2008) considered interdisciplinary research as the key to achieve great scientific breakthrough and innovation. young graduates to conduct an interdisciplinary study to reveal the importance of novel technology. Jencks(1995)said that architectural design in modern world was for viewing largely, either by public or via the lens of cameras. However, he considered that such design led to unfavourable interaction between structures and users. Thus, he believed that all senses, instead of simply visual sense, should be included in terms of architectural design. I am in favour of such a notion. The public are growing increasingly aware of the importance of buildings to health. On the whole, current architectural design involves environmental design, structure design, operation of construction, etc. However, an architect may have limited understanding with respect to other related fields or subjects, which can inhibit interdisciplinary research and communication in terms of subject history, language barrier and policy differences. Jencks(2016) believed that any aggressive architects should try to shift among different fields and gain more insights. Those lucky connection in science often originates from a different perspective of scientific laws. According to Elon Musk(2014), when he was working on the creation of Tesla, the design should abide by the rules of â&#x20AC;&#x2DC;first principleâ&#x20AC;&#x2122;, representing objectivity and fundamental physical phenomena.

Architects should to simplify and establish the common points among different fields, and thus determine the correlation between environment and human bodies and work on their designs from the perspective of users.

Changes of physical factors in architectural space can create a healing environment. The basis of the Quantum Theory in physics attempts to seek the most economical way for everything, i.e., to try to reduce energy consumption. Likewise, a healing environment aims to supplement and replenish the energy of users and generate a sense of comfort, thereby improving their immune system and the ability to self-repairing. Correspondingly, the morale of cancer patients can be improved, and their mental burden can be reduced when hospitalised. Based on those published findings, Squires(1993)described the design for medical service as evidence-based design. Moreover, the definition of rehabilitation environment has become the evidence-based construction. Based on some scientists, a healing environment can be considered as a physical environment where the positive interaction between patients and medical staff can achieve favourable results. Evidence has also suggested that a scientific design can also avoid accidents (e.g., falls and infection, increase privacy protection, comfort and sense of control). Therefore, the study on physical environment is key to the shaping of a healing environment.

1.3 Review of literature on physical features in the healing environment of cancer hospitals In the context of architectural design, the mentioned factors can basically fall to four types (Shuqing and Leiqing, 2017): (1) Ambient features: lighting, sound, smell and dimensions (2) Architectural features: Architectural factors refer to the features of the building that are relatively durable (e.g., spatial plane, room size and window position).

(3) Decoration features: Compared with architectural factors, decorative factors have a relatively low durability, belonging to factors that are easy to change (e.g., furniture, colours and artworks).

(4) Facility features: Equipment factors refer to facilities that directly improve the physical and mental health of the individual, including wash basins that clean the skin, reduce the risk of infection, and HVAC that improves the userâ&#x20AC;&#x2122;s physical comfort (e.g., types, heating, ventilation and air conditioning systems).

For example: According to environmental factors with healing effect in physical environment proposed by the Malkin (2003): (1) It can eliminate the negative effects of noise, glare, lack of privacy and poor air quality, which tend to cause pressure and other conditions; (2) It can promote users to have a full access to natural elements (e.g., outdoor scenery, indoor garden, aquarium tank and waterscape); (3) Provide users with more choices to enhance their sense of control. The mentioned opportunities refer to the right to choose for privacy and social conditions (e.g., lighting level control, type of music, seating arrangements, and quiet or active waiting areas).

(4) Be able to provide social support (e.g., providing a relatively private place of communication or accommodation for family members and other escorts); (5) Can distract users' attention (e.g., interactive art, fireplace, Internet service, music, video programs that play natural images and soothing music); (6) It can stimulate positive spiritual interaction and make people feel hopeful, thinking, associating, relaxed and happy.

CHAPTER 2 RESEARCH QUESTIONS 2.1 What are the principles underlying the healing mechanism in the context of cancer rehabilitation?

2.1.1 Environment can stimulate the internal reactions of individuals, which will act on the physical health and emotions of cancer patients and which can be detected.

Since the brain areas controlling emotions also control intention, attention and attitude, positive stimulus often goes together with the improvement of attention, emotion adjustment and awareness(Ellis and Whiteley ,1979) Many researches proved that the structure and function of related brain areas can change with external stimulus. In the book The Theory and Practice of Group Psychotherapy written by Irvin D. Yalom (1995), plenty of proved research is provided.

As obviously suggested from the table, cancer patients under treatment are significantly higher in terms of anxiety, depression, anger and others, while the result of those voluntaries who have already recovered are fluctuating in a normal scope. According to Burgess et al.,(1998), the reasons that can cause negative emotions in cancer patients are elucidated below: (1) Over-anxiety or depression refers to abnormal psychological status between normal people and highly severe mental disorder. Patients are commonly found to be anxious or depressed, or even both.

(2) After an operation, it may be difficult for patients to adapt to the situation and thus develop abnormal or unusual notions. For instance, the disability attributed to the surgery may affect the emotions of patients negatively. Thus, patients may be unsatisfied with his or her appearance, feel inferior and lonely, and unwilling to socialize with others, further increasing the negative emotions (e.g., anxiety and depression).

(3) Weakness and anger may be felt by patients and impact the results of recovery in rehabilitation for several problems (e.g., vomiting, insomnia and anorexia).

However, through the study of Burgess et al.,(1998), he improved the impact of positive emotions and reduced that of negative emotions by cognitive emotional regulation of cancer patients (e.g., attention transfer, no meditation or catastrophic thinking, as well as more positive collisions in social interaction through sensory stimulation of the environment).

The major findings of Dryden(2003). in his study in Rational Emotive Behaviour Therapy include: Direct reasons for peopleâ&#x20AC;&#x2122;s emotions are not objective events but subjective awareness. As impacted by the disparity in the subjective judgement and comments of people, the results of the same events may be totally different. Therefore, it is peopleâ&#x20AC;&#x2122;s attitude towards events, instead of the events themselves, that may stimulate emotional and behavioural responses. According to Dryden(2003), thus, the best and most dramatic and long-lasting method to get rid of negative emotions is to change the unreasonable belief values and religion. In the lecture review above, we have investigated the impact of physical factors on the emotions of people. As a result, through the stimulus of the physical features in the environment, a continuous intervention between environment and individuals, or a symbiotic relationship, is formed. I support that some unique factors in physical environment may be considered key elements for healing.

2.1.2 Impact of physical features on mental and physical features of cancer patients (1) Impact of ambient features on mental and physical features of cancer patients.

For example, negative effects attributed to noise, lighting, privacy loss, and bad air quality can be eliminated. And users can be fully exposed to outdoor scenes (e.g., gardens and fishing bowls). This can stimulate the positive mental reactions in patients and enable them to think, imagine, hope and relax.

(2) Impact of Architectural features on mental and physical features of cancer patients.

Communicative space that can contribute to socialization (e.g., game room, psychological consulting room and shared kitchen) can impact the emotions of patients. Besides, emotions can cause the emergence and impact the rehabilitation of illness. Patients not able to vent their negative emotions are inclined to suppress them and cover their true feelings. When faced with frustrations, such negative emotions can be magnified. These patients tend to suffer from disappointment and anxiety and long-term negative emotions, thereby adversely affecting the recovery of cancer patients. The design of architecture factors can create more opportunities for patients to control their emotions. Such opportunities aim at privacy and socialization (e.g., lighting levels, types of background music, seating arrangement, peaceful yet active waiting rooms).

(3) Impact of decoration features on mental and physical features of cancer patients.

Decorations can offer distractions for patients. Decorations can include interactive art objects, fireplace, Internet service, soft music, videos on nature, etc. The mentioned decoration factors can influence the mind of patients and enable them to relax. Community voluntaries can assist patients to adjust to the life in the new environment and provide care and visit like a relative or a friend. Families and relatives of patients can make changes in the environment, e.g., putting up pictures on the wall, to help patients relieve their stress and strengthen their closeness to the healing environment.

(4) Impact of facility features on mental and physical features of cancer patients.

Many people suffer from cancer due to tiredness and long-term stay in uncomfortable environment in which they do little exercises. This leads to the decline of their immune system and chronic illness. Studies have shown that such chronic diseases which persist for long periods can lead to cancer. Therefore, cancer patients should follow the instructions of their doctors and do appropriate amount of exercise to improve their internal state and increase the possibility of full recovery. Over-exposure to air-conditioning, unsanitary habits, unbalanced dies can all lead to illness. As a result, some designs can be made in terms of facilities (e.g., recycling of trash, disinfection by ultraviolet lights, air purification).

A symbiotic relationship between a cancer patient and the physical environment (Fig. 2)

Fig. 2 is drawn by the author 2.2 How can those principles inform the work by architects when designing a healing environment?

Before answer this question, this study first defines the scope of our discussion, “Healing environment” came from psychological studies. It is key to distinguish between ‘treatment’ and ‘healing’. The former refers to basic medical behaviours, while the latter involves three factors, namely body, mind and spirit, which means the recovery of both physiological and psychological state. Therefore, the design of hospitals should serve more than just to meet medical procedures but should strive to construct a suitable natural, social environment. Based on the interconnection between medical procedures and physical health, this part will focus on five types of typical functional spaces respectively ， including landscape Public space, semi-public space, public space, private space, Special medical space. And we will study the interaction among physical factors and the design methods used.

Hospital Spaces in which cancer patients experience in the medical procedures include those where patients stay when they wait, receive treatment, rest, etc. The process of treatment can cause mental and psychological stress, and influence the recovery results. By the improvement of such factors, including the medical staff and patients’ relatives. Some physical features may seem insignificant, yet the results of such physical features can be quite obvious. For example, the communication among people can produce subtle yet cumulative influence. Next, we will continue to discuss the four types of physical features: ambient features, architectural features, decoration features and facility features. I will further explore the how the shaping of a healing environment can positively intervene into the rehabilitation of patients.

According to Van der Linden et al(2015), he conducted an in-depth interview with designers who designed the Maggie Cancer centre, and I reorganized their understanding of "rehabilitation environment" in

architects' design. The order was adjusted according to the five types of architectural space, with the purpose of further analysing and discussing the expression of "rehabilitation environment" in different stages of the design process.

2.2.1 For landscape, architect can optimize the healing space through the following design, with green spaces as an example: According to Cuff (1989)â&#x20AC;&#x2DC;In the interviews with the designers, several themes could be identified. For instance, they associated healing environment with nature. This may not come as a surprise, given its origin in research on restorative environments (Kaplan and Kaplan, 1989), and the consideration of environmental factors in debates on architectural quality (Day, 2002).â&#x20AC;&#x2122;(Fig. 03) (1) Ambient features Vegetation and water in the courtyard can provide pleasant sound and fragrance, which make cancer patients feel pleased and relaxed and thus contribute to the improvement of their illness. Studies have shown that the sound and scent in nature can help brains to secrete dopamine, which helps to improve emotions of patients.

(2) Architectural features The design of courtyard should facilitate activities. For instance, a scenery belt can be included as a place for socialize. Normally, a centralized court is hard to access, except for the centre part. By comparison, a discrete court is easily accessible. Besides standard services, some spontaneous activities can also take place frequently in such a court to enhance the sense of existence of cancer patients.

(3) Decoration features The design of a court is the symbol and combination of some imaginary metaphors. It can express the understanding of designers in terms of the spiritual needs of cancer patients, as well as developing positive thinking. For instance, a labyrinth design can be used to strengthen the self-awareness of cancer patients. Meanwhile, further division can be made for relatively large courtyard to create changes in visual effects and specialize spaces for different standard services and activities.

(4) Facilities feature The design of courtyard can be used for air quality improvement since fresh air is conducive to help cancer patients rehabilitate. Therefore, as an intervention factor, such design can and should be used in the central court to produce fresh air and reduce the hazard of pollution.

Fig. 03 is drawn by the author

2.2.2 For semi-public space, architect can optimize the healing space through the following design, with Kitchen space as an example: About the design of kitchen space, according to Van der Linden et al(2015), ‘Being more particular to the Maggie’s Centres refers to a focus on domesticity, as promoted by the Maggie’s Trust to support relaxation – a philosophy Jencks and Heathcote (2010) entitle Kitchenism. Furthermore, spatial experience – architects’ core business, is another important theme in design. (Fig. 04) (1) Ambient features Natural light is recommended in a kitchen. However, a full glass-window should be avoided to prevent the cage effect since cancer patients follow a declining self-adjustment mechanism.

(2) Architectural features.

A kitchen should provide snack sections near consulting or activity rooms. Cancer patients, as we all know, have a weaker digestion for long-term medication and treatment, so they are supposed to dine more often but eat little each time. It is particularly recommended that they eat and gain energy nearby immediately after therapy or treatment to reduce tiredness. The design of a kitchen should be flexible and consider all other socializing areas, including those where seminars and saloons conducive for the health of patients are held. When near the centre of a building, a kitchen is more often walked through (Van der Linden et al,.2015). It refers to a place where cancer patients are more likely to stop, talk and listen to their peers. Such communication, or socialization, is critical to increase the sense of pleasure and existence for cancer patients. Moreover, the transparency level of light can impact the willingness of cancer patients to stay. Thus, when a kitchen cannot be placed in the centre of a building, several measures can be taken to enhance the socializing function of a kitchen and attract more patients to stop and communication. For instance, partition walls no more than 90 centimetres can be set. Other ways include an island bar with glass materials Jencks and Heathcote (2010.”

(3) Decoration features The colour of decoration materials in the kitchen should help stimulate the appetite of cancer patients. For instance, an orange pomegranate picture on the wall is capable of stimulating patients to secrete more saliva. Besides, a kitchen acts as the part in a medical building that resembles patients home the best, so it should be recognized as the crucial public space for psychological healinJencks and Heathcote (2010g.

(4) Facility features Noises of equipment in the kitchen should be reduced or eliminated to not disturb the emotions of cancer patients, since noises can bring about headache and nausea to them. Likewise, reasonable design should also consider the trash disposal to avoid unpleasant odours and keep the kitchen well-ventilated (Van der Linden et al,.2015).

Fig. 04 is drawn by the author

2.2.3 For semi-public space, architect can optimize the healing space through the following design, with Activity space as an example: For the design of activity space, according to Van der Linden et al(2015), this can be termed as collective consumption (Crilly et al, 2008), for the established ethos of the support service acts on user experience.

However, designers place a major emphasis on the physical environment, and the impact of the social context should be recognized as well.â&#x20AC;&#x2122;(Fig. 04) (1) Ambient features Natural and incandescent light are recommended in public space to ensure that cancer patients can have a clear sight. Tiredness attributed to direct sunlight should be avoided(Crilly et al, 2008),. Rooms for reading, creating and teaching should be placed in the places where people travel to frequently. Furthermore, public activity space should be connected with gardens, since the natural factors in the gardens can positively impact the emotions of cancer patients(Van der Linden et al..2015).

(2) Architectural features Public activity space is required to be completed with specific boundary. Temporary partitions can be added to create privacy if necessary(Crilly et al., 2008). The standard services provided by public activity space should include team activities, seminars, training sessions, hobby teams, and writing. Activities in teams, involving mutual help among patients, are supposed to exhibit a lower level of openness, while rooms for reading, creating and teaching, which include random talk, should show a higher level of openness (Van der Linden et al,.2015).

(3) Decoration features Since activities can cause distractions in cancer patients, the design of public activities space should be clean and simple to reduce psychological oppression and tiredness resulting from heavy decoration. When the public activity space is partitioned only by short walls, furniture, and others, cancer patients will feel free and relaxed to choose standard services(Crilly et al, 2008). Since it is commonly difficult for cancer patients, especially advanced patients, to move around, the flexibility and comfort of rooms are of high importance to them. Relaxing building design enables patients to feel like home(Van der Linden et al,.2015).

(4) Facilities features Sweating after exercise brings cold to cancer patients, who have lower immune systems and are more likely to develop cold complications. Accordingly, it is of great significance to keep the domestic temperature and humidity stable(Crilly et al,. 2008). According to GB/T 5701, in summer the best domestic temperature ranges from 23 and 28 degrees centigrade, and the optimal moisture in summer is 30% to 60%; in winter, the best domestic temperature is between 18 and 25 degrees centigrade and the best moisture ranges from 30% to 80%.

Fig. 04 is drawn by the author 2.2.4 For private space, architect can optimize the healing space through the following design, with Psychological counselling room as an example About the design of Psychological counselling room, according to Van der Linden et al(2015), considerable efforts were committed in meditation spaces and the entrance to respond to visitors’ emotional needs.

Architecture’s ability to intensify experiences, through materials (Zumthor, 2010), intimacy gradients (Day, 2002), or by providing spatial metaphors for mental changes (Malnar and Vodvarka, 2004; Worpole, 2009), seems part of architects’ common knowledge (Fig. 05) (1) Ambient features Together with waiting rooms, psychological counselling rooms exhibit the basic function of providing one on one assistance and information to cancer patients. Besides, doctors carry out professional training in terms of how to relax, reduce stress, improve sleep, and others(Zumthor, 2010). The quality of the environment inside the counselling rooms is related to the level of privacy brought about and determined by visual limitations (Van der Linden et al,.2015). However, it shows no association with the size and dimensions of the rooms, and location of the building. In other words, a psychological counselling room is not necessarily fixed sized, or far away from the centre of the building. Instead, the layout of a counselling rooms is determined by how they are arranged. There are three ways to arrange the mentioned rooms.

They can be arranged side by side, discretely, or in other unique ways.

(2) Architectural features

Specific and separate rooms are created when functions are clearly defined, while partitions, e.g., L-shaped and U-shaped partitions, are commonly used when the whole space is a continuous system to avoid breaking the fluidity of the whole space. When partitions or walls are transparent or translucent, visitors can maintain the subtle balance between keeping their privacy and meanwhile be careful what is taking place outside(Zumthor, 2010).

(3) Decoration features Background colours (e.g., blue and gray) that can help patients calm down are recommended. Such colours can help cancer patients gain composure and psychological comfort.

(4) Facilities features Cancer patients are inclined to be mentally fragile in psychological counselling. To help them feel better, tables, chair and other furniture should be soft and protective and the back of chairs should be against the wall to generate a sense of security(Zumthor, 2010).

Fig. 05 is drawn by the author 2.2.5 For special medical space, architect can optimize the healing space through the following design, with Daytime wards as an example (1) Ambient features Transfusion rooms should be designed to face south. Besides, since transfusion takes place largely in the daytime, glass partitions should be employed to split the whole room into different parts to ensure sufficient lighting. Given that typical transfusion can take up to 5 to 8 h,Berg (2005) better effects can be generated in such an environment as natural scenes outside the window are capable of stimulating positive reaction inside the bodies of patients, thereby facilitating the absorption of medicine(Tate and Forchheimer, 2002).

(2) Architectural features The proportions of beds and nurses to patients are required be adjusted properly. From the traditional perspective, the rate of patients to medical staff ranges from 1 to 0.7.Berg (2005) It is required that there are at least 5 oncologists, seven nurses, and two nurses with PICC certificate in a room of 100 patients. In the rehabilitation of lone patients, i.e., patients without company of their family members should be arranged favourably and nearer to the staff office to satisfy their psychological needs easier and achieve more effective effects. (Fig. 06) (3) Decoration features Wooden materials are recommended in the wards, since wood feels soft. Moreover, existing studies reported that wooden materials make people feel comfortable and relaxed, thereby facilitating rehabilitation. Besides, oppression attributed to dark materials should be avoided(Burgess and Haaga ,1998).

(4) Facilities features Fundamental facilities consist of transfusion chairs where patients can lie down, portable transfusion pumps that can be taken home, and other first-aid facilities (e.g., ambulance, oxygen supply equipment and electrocardiogram monitor). To achieve better therapeutic effects, other service facilities can be included too (e.g., more chairs for visiting family members, televisions, newspapers and magazines, microwaves, as well as water dispensers). Such facilities help cancer patients reduce the anxiety and loneliness during their transfusion(Burgess and Haaga ,2018)

Fig. 06 is drawn by the author

2.3 Summary list In summary, to begin with, the landscape public space (e.g., courtyards and gardens) can dramatically change the vertical mode of hospital development, largely highlighting traditional treatment. Second, semi-public and public space can be formed as a major socializing place, and communicative function of small-scale structures can be provided. Different activities are designed (e.g., reading, artistic creation and teaching) to create an environment for the interaction between patients. Next, private space is created (e.g., consulting rooms and meditation rooms) to offer consulting assistance for patients and protect their privacy and dignity. Lastly, special medical space (e.g., daytime wards) are employed to provide medical assistance for the mentioned rehabilitation activities. The mentioned physical factors should be designed based on their major functions. According to Blakenham and Keswick (2007: 29), â&#x20AC;&#x2DC;it creates spaces that makes it easier to be with other people by creating a comfortable balance between public and private; thus, you feel safe, while your imagination is stimulated unconsciously, then it has done even more.â&#x20AC;&#x2122; Landscape : the green space Environmental features: green vegetation, sound of flowing water and fragrance Architectural features: frequent spontaneous activities Decoration features: symbolic meaning, specialization of standard services Facilities features: improvement of air and reduction of pollution Semi-public space: the kitchen Environmental features: natural sunlight to keep away from cage effects Architectural features: nearby snack bar, flexible arrangement, near the centre which contributes to socialization.

Decoration features: orange colour to stimulate appetite, home-like atmosphere Facilities features: avoid unpleasant odours and keep well-ventilated Public space: the activity roomďź&#x161; Environmental features: a clear vision and no tiredness from direct sunlight Architectural features: a complete and continuous space exhibiting specific boundary and high openness Decoration features: clean and simple to avoid oppression and tiredness from heavy decoration Facilities features: steady temperature and moisture, 38 to 40 degrees centigrade Private space: the psychological counselling room Environmental features: present basic training and information Architectural features: transparent or translucent partitions to keep the subtle balance between privacy and awareness.

Decoration features: background colours that can help patients calm down Facilities features: sense of security generated by the choice and arrangement of furniture.

Special medical space: the daytime wards: Environmental features: south-faced transfusion rooms, ample natural light and outside views Architectural features: sufficient beds and professionals, favourable arrangement for lone patients.

Decoration features: wooden materials are prioritized, and dark colour materials are avoided.

Facilities features: fundamental facilities, first-aid facilities and service facilities

2.4 Assessment of the potential impact of the Cancer Hospital Design factors on healing of cancer patients

CHAPTER 3

CASE STUDY

Before starting this chapter again, I want to give an introduction to the sources of data and images.based on the Internet search, most my data of case information comes from Our buildings (2020),Our story, (2020)and Our centre (2020).

As stated by MacLeod(2020) in â&#x20AC;&#x153;The Architecture of Hope," a book about such cancer rehabilitation facilities, modern hospital architecture reveals an urban aberration, whereas the Maggie Cancer Rehabilitation Centre is at the crossroads between the city, the large hospital and the human race. It's a fusion of the future. To be specific, its hospitals have been transformed into hotels, shopping malls and high-tech factories. This fusion is a bridge between pure function and symbolism, and provides psychological, social, and informational guidance. This will become a standard type of building.

3.1 Case Study on Maggieâ&#x20AC;&#x2122;s Cancer Caring centre, Manchester by Designed by Foster + Partners (2016), it received the Prize for Medical Structure offer by ArchDaily one year later in 2017.

Design concept: As stated by Norman Foster (2020), the inspiration of the centre was from his abundant first experience

from his long term stay in the place. Besides, Mr. Foster had been fighting against cancer for up to ten years, so he was well aware of the importance of such a centre to cancer patients. He considered that architecture can significantly cheer up people and help patients recover. Moreover, this centre is the one with the largest scale. (www.fosterandpartners.com, 2020).

Ambient features The centre is adjacent to the largest cancer treatment centre in Europe - the Chrystie Cancer centre, covering an area of 1922 square meters, which is a one-storey structure made primarily from timber. The roof of the centre is triangular, centred by a dome, which forms a hollow long corridor inside that allows sufficient sunshine to enter. Looking from outside, this centre seems like a long, one-storey museum, and the wooden frame makes the structure well fit into the surrounding green environment.(Jencks, 1995) The majority of external space is covered by large gardens and internal greenhouses to encourage people to walk out and experience real nature. Each treatment room is faced with a small greenhouse that allows patients to grow flowers and plants, have parties and enjoy the nature. Mr. Foster said that the centre of the building refers to ensuring that the patients will not lose the pleasure of life for their fear of death. Such a healing environment can help patients get rid of the gloom in the fight against cancers (www.fosterandpartners.com, 2020). (Fig. 07)

Fig. 07 from www.fosterandpartners.com Architectural feature The entrance of the centre is not conspicuous. It is on one side of the building, as surrounded by low walls and vegetation. Visitors can find it by signs. The inside of the centre combines various functions (e.g., treatment rooms, counselling rooms, libraries, fitness centre, socializing space and a greenhouse). The core part of the building refers to a kitchen equipped with large, shared dinner tables(Jencks, 1995). The kitchen offers various foods and drinks, allowing both patients and staff of the centre to dine and communicate here. Unlike the reception of conventional hospitals, there will be no long line of anxious people, neither the registration and appointment procedures. Elements in conventional hospitals are tried to be avoided, and the internal space was tried to feel like a home(Our buildings, 2020) (Fig. 08)

Fig. 08 from www.fosterandpartners.com Decoration features The design and decoration of the inside apply natural timber and warm, cosy colours. The floor is covered with dark blue royal bricks, and the furniture is fashionable and comfortable. Colourful carpets and ornaments are arranged everywhere, allowing the whole design to reveal full of modernism of north Europe (www.fosterandpartners.com, 2020). (Fig. 08) Equipment design Forster + Partners is significantly strict with natural lighting. It is one of the aims to design the inter-layer, covering ten tables for staff as their working places (www.fosterandpartners.com, 2020). (Fig. 09). The internal storage room can prevent a messy situation. Medical staff can go to their patients to support any help rapidly. The acoustic ceiling is capable of ensuring a peaceful environment. All other rooms are open except for the counselling room. A library is set in the centre, including a wide range of books and magazines. It is noteworthy that the design of the bathroom is unique. Besides all the necessary functions, the designers have provided the private rooms for patients to vent their negative emotions(Our story, 2020).

According to what a medical worker does (Our story, 2020). Instruments detect feedback signals through visual or auditory sense, amplify them and make them detectable by humans. We can manipulate various signals (e.g., respiration and rate of heart) to improve the status of internal organs as well as the physical status of patients. Accordingly, the healing effects of environment can be presented clearly.

Fig. 09 from www.fosterandpartners.com

3.2 Case Study on different architectural Spaces of Maggieâ&#x20AC;&#x2122;s Cancer Caring centre Landscape : the green space According to Maggie's Lanarkshire, England, county, (Our centres, 2020), the outside garden in the north was designed by Arabella Lenox-Boyd, containing a labyrinth similar to the Chartres Cathedral. The architects designed a long slope to lead the visitors to enter the building through the entrance, whereas such slope intentionally obscures the boundary between the building and the outside world. The labyrinth has a special meaning, with the S-shaped line signifying the stories of life. Visitors walk upwards the path, which reveals the amelioration and worsening of cancer. All of the mentioned make cancer patients considered that they can find their path and solution. New planted vegetation refers to a sign of entrance and visitors can follow the guidance by the sculptures into the yard, which is quite welcoming and can help get rid of the fear and negative emotions. On the whole, the evergreen plants and the benches along the paths covered with pebbles are well embed into the entire design. Moreover, the layout of the outside curved walls and the wooden house made of oak split the court into three parts, which can satisfying the needs for activities of different privacy requirements. (Fig. 10)

Fig. 10 from (Our centres, 2020)

Semi-public space: the kitchen According to Maggie's Lanarkshire, England, county, (Our centres, 2020), the designers arranged the kitchen at the heart of the structure to make it a converging point of both vision and mobility. Besides, they made the dinner tables triangular to adapt to the fractured space. The critical position of the kitchen can also effectively confine the continuous space, with self-service bars and long tables as the visual centre of a space without borders. (Fig. 11)

Fig. 11 from (Our centres, 2020)

Fig. 12 from (Our centres, 2020)

Fig. 13 was designed by Steven Holl to sit alongside the Great Hall. It opened in 2017. (Our centres, 2020)

Public space: the activity room OMA refers to a model of circular, continuous space when the Maggie's Centre, (Fig. 14) Gartnavel Hospital as designed in 2011. (Our centres, 2020). Almost all the public activity space faced the central courtyard, forming a continuous circle full of varieties. Rem Koolhaas introduced L-shaped walls to create activity and counselling rooms of varying sizes to satisfy the needs of different teams and session training. Such space, involving both closure and openness, both continuity and fracture, together with special layout of rooms, reminds people of the circular corridors of a hospital in the Medieval and Renaissance period, as well as the Muslim clinics. It is also a compliment to the abstract skills adopted in the Barcelona Pavilion designed by Ludwig Mies van der Rohe. The spiral windmill layout of the rehabilitation centre weakens the centre of the irregular geometric centre, while strengthening the stretching of space. Furthermore, it also attempts to develop direct and deep correlation with the surround scenes (Our buildings, 2020).

Fig. 14 was designed by OMA, the author rearranges.

Private space: the psychological counselling room Psychological comforting room (Fig. 14) is designed to address the nausea, vomiting, anorexia, tiredness caused in cancer patients by anxiety and depression. Patients are treated by CT system, meditation, biological feedback and medications. The arrangement of the meditation rooms is inconsistent with that of other rooms. Except for the very basic space used as the office of medical staff, there are no table or chairs.

Patients usually sit or lie on the two sofa chairs, with their hands settled in a relaxed way when they listen to meditation music. Meditation rooms face evergreen plants, and the light inside the room is generally soft and dim, helping patients to concentrate (Our buildings, 2020).

Fig. 14 was from (Our centres, 2020) Special medical space: the daytime wards The uniqueness of children cancer centre is revealed in the loss of the ability of the patients to do self-control and self-adjustment. Accordingly, more Architectural features and more mechanisms should be introduced in the design of the cancer centre for more protection. Besides, different rehabilitation areas should be painted in different colours and styles as children exhibit higher sensitivity to colours than adults. (Our centres, 2020) The whole expanding project massively used red, blue, yellow and others to build a pleasant and sweet atmosphere for children. Moreover, potted plants and domestic sculptures are used to create a home-like experience. Furthermore, the internal space of all sectors is designed based on the uniqueness of children.

For instance, chairs of various designs are provided for children to choose. Besides, walls and ceilings are covered with various cartoons, flower, plants and abstract geometric pattern. A series of distracting elements can help arouse the attention of children and increase their willingness to take long-term rehabilitation treatment. Meeting rooms, analysis room and interactive space for children are intentionally connected, which can deepen the cooperation between medical staff and families of the patients, as well as expanding the office space of medical staff of the hospital. Beds are classified as single beds and double beds. The former is designed with sufficient room for family company and the communication and play between children, while the latter rooms are relatively small in area and split by curtains.

CONCLUSION Architect Steven Holl(2016), in the explanation of his ideas for designing, stated that space is used for curing the pain of cancer. According to Norman Foster (2016), a cancer hospital should be built as an inner garden for cancer patients (www.fosterandpartners.com, 2020). The designers at OMA asked themselves ‘what would a cancer patient need most for an environment?’ and answered ‘they necessitate an environment where they can relax.’ (Our story, 2020). This dissertation answers the question of how we should design a healing environment to help cancer patients settle the last period of their life. Besides, architects can establish such a healing environment to provide more value and the positive effects mentioned here.

Thus, when starting my work to design for medical buildings, I asked myself to what extent architectural design creates a healing environment in cancer hospitals to facilitate the recovery of cancer patients. When coming to Manchester for my postgraduate studies, I decided to continue this subject. This dissertation analyses the physical features in the specific environment of cancer patients in their rehabilitation, as well as presenting how such features should be generated to build a healing environment and impact patients positively.

First, the history and variety of healing environment and the physical factors in cancer hospitals are described and explained. Besides, the mentioned factors are classified into two groups based on the feedback of cancer patients: factors affecting patientsâ&#x20AC;&#x2122; emotions positively and those affecting patientsâ&#x20AC;&#x2122; emotions adversely. Subsequently, I discuss the impact of the changing physical factors in various spaces on the environment. Moreover, in terms of an architect, the four physical features are described, i.e., ambient features, architectural features, decoration features and facility features. Lastly, after collating primary data from the research reports of hospitals with respect to the process of patients 'rehabilitation and from the websites and database of typical cancer care centres, I combine the mentioned data with relevant theories and further my demonstration from five perspectives, i.e., landscape, public space, semi-public space, private space and special medical space.

As argued in this dissertation, architects can create a healing environment based on their design skills and arrangement for the benefit for cancer patients. For instance, kitchens should be designed with large dinner tables and fireplaces as they are capable of encouraging cancer patients to socialize. On the principles of the healing mechanism under cancer rehabilitation, the way in which environment can stimulate the internal reactions of individuals is discussed, which involved the reactions on the physical health and emotions of cancer patients. Furthermore, I present how to help patients gain positive emotions and avoid negative ones by shaping a healing environment based on the physical features inside. Therefore, different methods should be adopted to deal with physical features based on the diverse demands of patients for their spaces. I also argue that in spite of the fact that the use of chemical and medical equipment can elevate the survival rate of patients, the great pains that go with such equipment cannot be overlooked, which, again, reveals the significance of desirable architectural design on cancer patients and that of the insights of architects into the role of medical buildings.

By analysing the cases of maggie's cancer caring centre, it is suggested that patients there can be alone, whereas they are not lonely. The success of this cancer centre is reflected by its attention to humane care.

Thus, the role of an architect lies in the expression of space, as well as the creation of empathy with their users. Moreover, one vital factor to a successful design refers to the combination of designing skills and the usersâ&#x20AC;&#x2122; demand to build a healing environment. For this reason, I place an emphasis that architects should be aware of the fact that their design is to serve a special group of users. Furthermore, I assert that though it is space that architects should focus on, the impact that their design can exert on their users should be considered as well. Lastly, I believe that architects can create a better healing environment based on their design and arrangement of the physical features. (Fig. 15) In the present dissertation, a conclusion is drawn that a clear connection exists between the rehabilitation of cancer patients and their environment. A healing environment can be established by designing physical features, which will help cancer patients increase their survival rate and reduce their recurrence rate. We expect that more improvements can be achieved and more healing architecture can apply the mentioned theories to lower the cost of cancer treatment. Hopefully, this dissertation can be of help and value.

Fig. 15 is Charles Jencks and his wife, Maggie, who are founders of Maggie Cancer Centre (Our centres, 2020).

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