The Value of Integrating Visual Arts: Evaluating the Benefits of Hospital Room Artwork on Inpatient Wellbeing
Condition: Cancer
Study type: Interventional

Summary: 
      The Value of Integrating Visual Arts (VIVA): Evaluating the Benefits of Hospital Room Artwork
      on Inpatient Wellbeing will use a large randomized controlled trial design to investigate how
      the inclusion of visual arts in the hospital rooms of cancer patients benefits their
      quality-of-life during treatment. This 18-month research study will provide hospitals with
      evidence of the therapeutic value of the visual arts as measured by patients' perceptions of
      anxiety, pain ratings, use of pain medications, need for nurses, and length of stay. Data
      also will be collected on patients' evaluation of hospital rooms, specifically on décor
      including artwork, so as to correlate patient wellbeing with the presence of artwork.
      Ultimately, this project aims to increase support of and appreciation for the arts from a
      major consumer-namely, healthcare providers-by justifying the value of integrating local
      visual art into inpatient rooms and providing patients with aesthetic choice during their
      stay.
    

Detailed description: 
      The arts have long played a role in health and healing dating back to the 14th century when
      paintings ushered patients to a good death or immortalized patrons for charitable activities.
      Today, about half of all hospitals have dedicated art programs ranging from permanent
      displays of art throughout their buildings to art therapies at the bedside and performances
      in public spaces such as waiting areas. Offered to patients with a range of conditions, their
      families and visitors, those programs aim to "improve patients' overall health outcomes,
      treatment compliance and quality of life". Yet, while patient surveys indicate interior
      design features such as artwork can make hospital environments less institutionalized and
      more emotionally pleasing, few randomized controlled trials have linked specific design
      features or interventions directly to impacts on healthcare outcomes. The Value of
      Integrating Visual Arts: Evaluating the Benefits of Hospital Room Artwork on Inpatient
      Wellbeing will add significantly to those data.

      The physical environment of the inpatient hospital room essentially provides a blank canvas
      on which to study the impact of visual arts on patient outcomes. Studies show that patients
      care about their physical surroundings, and while efforts in recent years have aimed to make
      hospital rooms less austere, in most cases, they remain institutional environments. The
      Pick-a-Pic Program at the Penn State Milton S. Hershey Medical Center addresses this problem
      by allowing patients to modify one aspect of their physical environment through the personal
      selection of an art print by a local, professional artist to be displayed in their rooms
      during their hospitalization. Placed in frames mounted on the walls directly in patients'
      line of vision from their hospital beds, these prints can help to create a supportive and
      comforting environment. Their efficacy is predicated on the capacity of visual arts to
      provide positive distractions for patients and family members coping with the stress of
      illness by adding a personal touch to the hospital environment and making the spaces as
      familiar and homelike as possible.

      This project draws upon distraction theory, which posits that patients who become engrossed
      in or open to a positive distraction attend less to their pain and even experience reduced or
      altered perceptions of pain. Changing even one environmental factor-such as introducing a
      visual stimulus-can provide that distraction. Burn patients, for instance, who watch videos
      of nature scenes with accompanying music during burn dressing changes were found to
      experience less pain and report less anxiety. Similar findings were reported for those
      patients who viewed a nature scene and heard nature sounds while undergoing a painful
      flexible bronchoscopy. In studies involving healthy volunteers, participants shown videos of
      nature scenes-some with music and some without-had higher pain thresholds and pain tolerance
      than volunteers who stared at blank or black screens. Positive distractions as part of the
      healthcare physical environment also have been found to be effective in diminishing feelings
      of stress and its accompanying psychological and physiological impacts. When videos, still
      art, and window film of nature images were introduced into two emergency departments,
      researchers noted reductions in behaviors indicative of stress and anxiety. Artwork has been
      found to have a positive effect on patients' moods as well.

      The proposed study - The Value of Integrating Visual Arts (VIVA): Evaluating the Benefits of
      Hospital Room Artwork on Inpatient Wellbeing - builds on these findings and advances them in
      novel and significant ways. First, this is a rare three-arm randomized controlled trial with
      large participant numbers designed to quantitatively assess the benefit of visual arts to
      individuals. The participants in our study represent a specific subgroup-i.e., patients-with
      a discrete disease diagnosis of cancer who are undergoing treatment in the Cancer Institute
      at the Penn State Hershey Medical Center. According to the Center for Disease Control, more
      than 19 million adults, or almost one in ten Americans, have been diagnosed with cancer.
      Widely known as one of the most disruptive illnesses affecting human beings, cancer treatment
      is painful and invasive, and patients and their families must cope with feelings of anxiety,
      vulnerability, and uncertainty - feelings that can be exacerbated by the stark medicalized
      environment. Positive visual stimulus in the form of artwork has the capacity to provide
      biopsychosocial respite that can be captured in measurable patient outcomes from this
      physical and psychological trauma. While this research study is particularly relevant for
      cancer patients, findings of this project holds promise for all hospital inpatients who are
      subject to the same sorts of environmental stimuli as they undergo institutional treatment.
      According to the CDC, there are a reported 35.1 million inpatients annually receiving care in
      U.S. hospitals, and the average length of stay is 4.8 days. As clinical and economic data
      have traditionally carried the greatest weight in decisions by hospital administrators, this
      study has the potential to produce strong scientific data establishing the visual arts as an
      environmental modification with clear and persuasive benefits for a hospital and its patients
      that deserves investment.

      This study also is innovative in linking measurable patient outcomes to patient control of
      one aspect of the hospital physical environment-namely, artwork for inpatient rooms. Studies
      that have examined artwork and physiological outcomes have largely involved views of nature
      from windows or representational nature scenes, both of which have been provided to rather
      than chosen by patients. In studies involving patient choice, the focus often has been to
      determine patients' preferences for different kinds of artwork-e.g., representational nature
      scenes vs. abstract, rural scenes vs. urban-with an eye to developing guidelines for art
      selection and placement. While qualitative data exist that show patients who are able to
      influence their physical environment report increased feelings of emotional and physical
      comfort as well as improved moods, few studies have used rigorous study designs to measure
      the benefit of choice of artwork on medical outcomes.

      Finally, this study is innovative in using a single lens-visual arts-to examine the benefits
      of the arts in hospital rooms on patient satisfaction, a key parameter to healthcare
      providers in today's competitive market. Other examinations of the physical environment have
      included architectural features such as size and shape of hospital rooms, ambient features
      such as lighting and temperature, and colors. By specifying room décor in patient
      satisfaction surveys, this study can provide hospitals with strong and persuasive data on a
      relatively low-cost way to improve the aesthetics of patients' rooms. Indeed, prints of
      artwork used in the Pick-a-Pic program at the medical center cost about $90 to produce.

      This research study seeks to answer (1) whether the presence of visual arts in a patient's
      hospital room significantly improves patient outcomes as measured by perceptions of anxiety,
      reports of pain, use of pain medications, requests for nursing staff; (2) whether patient's
      personal choice of a visual arts print (versus having a print but no choice) significantly
      improves those outcomes; and (3) whether the presence of visual arts significantly improves
      patient satisfaction with the physical environment.
    

Intervention name(s): Artwork
Intervention type(s): Behavioral
Intervention description(s): Prints by local artists that are hung on the walls of patient rooms.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Supportive Care