KATI PEDITTO: I heard this is your first day of this seminar, so welcome. I also know that it is still the add/drop period, and you might be shopping around, so I hope you'll stick around in this class. I've actually taken this seminar before, and the interdisciplinary nature of the speakers that the folks at the Institute for Healthy Futures are going to bring in for you is a real treat. 

So I hope you stick around. It's just Friday mornings. You get a little bit of extra daylight, because it starts at 9:00. So I hope you'll stick around, or at the very least, you enjoy this presentation today. 

So I know that this is a health, hospitality, and design seminar. I think you'll find that for my presentation, a lot of it focuses on health and design, but that there are some pretty important implications of this research on how we might design hospitality spaces for adolescents and young adults. As Mardelle mentioned, this is a population that really hasn't received a ton of attention in terms of research on the built environment. 

And so when I say the built environment, I mean everything that surrounds us at most times during the day. You're either in the built environment, or you're in the natural environment. And for about 90% of our waking hours, we are in the built environment. So how we design these spaces really matters. And not very many people have asked young people-- teenagers, college students-- how they feel about the built environment. 

So that's where my research kind of intersects with health, hospitality, and design. I'm going to be talking, today, a little bit about what makes cancer during adolescence and young adulthood a particularly tricky challenge, and then I'll also present some of my own research with more of an emphasis on some of the tools that I used, because I think that they are not only relevant to my own research interests, but also potentially tools that you might be able to use in your various disciplines as you go out and think about how people are interacting in a certain space, and how you might optimize their experiences in those spaces, whether that's a hospital, or maybe whether that's the entrance to a hotel. 

We'll go through some design guidelines that are very specific to spaces for adolescents and young adults, and then I'll present-- pretty briefly-- some future directions that those of you who have a research interest-- maybe you're thinking about grad school-- some things that are still left undiscovered, and might be worth your attention in the future. 

Cancer during adolescence and young adulthood is very, very different than cancer in most other times of your life. There have been some researchers that have called adolescence the most difficult time to be faced with the burden of cancer. And now I'm going to tell you a little bit about what it actually means to be an adolescent with cancer in the United States. 

We actually consider adolescence and young adulthood from ages 15 to 39 when we're talking about AYA-- so Adolescent and Young Adult-- cancer in the United States. I'm sure you can imagine that there are some pretty substantial differences between a 15-year-old and a 39-year-old, and maybe even the 25-year-old in between. And this is a really, really odd concept, but it's entirely based in the biology of these cancers. 

Most cancers that affect AYAs-- and I'm going to use AYA, adolescent, young adult, kind of interchangeably-- which you really wouldn't do if this was a human development presentation. But I'm going to do that today because of the way that we've lumped them together in the health system. 

So the biology of these cancers are very similar between the ages of 15 to 39. So if you are a college student and you're diagnosed with cancer, your cancer's going to look probably much more similar to someone who's 15 and someone who's 39. So you're going to be treated with the best doctors-- you want to be treated with the best doctors, you're going to be where they are, and they are in pediatric facilities. 

So pediatric facilities are primarily where children are treated. And I'll tell you a little bit about how I even came to this topic in the first place. I had no idea that AYA was ages 15 to 39 until actually my first year of grad school. So I had already started my PhD. I had a very different research topic. And I decided that I really wanted a break from grad school. 

I had come straight from undergrad, needed a little bit of a breather, so I took a summer off. Thanks to the wonderful people in my department, that was possible. And on this summer off, I decided to run across the country. I linked up with the Ulman Cancer Fund for Young Adults out of Baltimore, where I'm from. 

They were looking for a grad student to direct a run for 49 days from San Francisco to Baltimore. It's one of the big fundraisers for their organization. And I had been here thinking, wow, I'm so burnt out. I really need a break. So how about running for 49 days? 

And I would never, ever do it again, but I would do it once. And some of the things that I learned along the way were really integral in not only presenting this problem and bringing it to the forefront of my mind, but also revealing a really important research challenge here-- and, consequently, a really important design challenge. 

Across the country we visited a number of different facilities and met with a bunch of young people our age. This was a group of 26 of us-- mostly college students, some grad students. And every time we met with a young person, we heard something pretty similar-- like, wow, it's so good to see people our age, or wow, this is so awkward. 

And it was because we were meeting people in pediatric facilities. So you're surrounded by primary colors, and stuffed animals, and balloons, and kids' toys, and cartoons. And when is the last time you just sat in a child's playroom? 

You're all college students, grad students. That's so awkward. So I came back to Cornell after the summer and said, man, not only are adolescents and young adults really facing some pretty serious physiological challenges when they're called on to deal with cancer, but also, now they're being treated in these environments that look nothing like the places that they came from. 

Some of you guys live on College Avenue, Linden Street. You've got your own, little town houses. Imagine if you were picked up out of those, and you were placed in a pediatric facility for treatment-- for maybe, potentially, three months, depending on the nature of your treatment. 

You all have all of this independence and all of your friends and all of this social support, and all of a sudden you don't, and you're surrounded by sick infants and little kids. So that leads to these really intense psychosocial outcomes. This is a group of young people who already have some serious mental challenges to get through. 

Even a healthy adolescent has a lot of turmoil in terms of human development in this time period. With the addition of cancer we see things like a 2.5 time increase in the likelihood of suicide-- even after you've survived cancer. So how do we create an environment that might reduce the really intense psychosocial impact of having cancer? 

In a study in 2001, a nurse was actually reflecting on how the environment might look to create not only a sense of healing and a sense of warmth, but also the importance of having peers around you in this space. How might the ideal space facilitate some relationships with other young people? Adolescents and young adults are social creatures. 

You learn from what your friends are telling you. You reflect, and you grow from the way that you interact with other young people. Certainly your family, your siblings are important as well. But when you're taken away from your ears, that could potentially delay development. 

So this nurse had this beautiful, lofty idea of a place that was not only welcoming and warm and healing, but also where you would gain social support from other people. This study highlighted the exact nature of this problem, and the reason that we have so little evidence on how to design for adolescents and young adults. 

At 19 years old, young people feel too old for a children's ward, but at 18 they feel too young for an adult ward. So where do we put them? How do we design a space that meets this critical need, when there's clearly no space that young people are fitting into right now? 

This is complicated even more by the fact that usually cancer treatment lasts quite a while. And even through survivorship, you're going to likely be seeing the same physician. So is there a way to create a transitional space that you can be in from young adolescence, at 15, up through older adulthood and age 39? 

This is a little bit about what we're dealing with right now. So there are actually a handful of places that have recognized this as a pretty big challenge. There are 7, 8, 9 facilities throughout the United States that have said, OK, we recognize the weirdness of this adolescent and young adult population. We're going to try to build a space for them. 

And so this is at Cook Children's Hospital in Fort Worth, Texas. And they said, we don't really have a lot of money. We think this is a really cool idea, but we don't have money, and we don't have space. And so they placated this one wonderful physician, who was really trying to work for AYAs. And they said, you can have this empty office. She was like, all right. 

So she took this empty office, and she tried to make it a teen-oriented space. She put in a couple opportunities for entertainment, distraction, recreation, some company furniture. Would you guys ever seek out this space? Probably not. 

When's the last time you went and sat in your dorm room common area if no one else was really in there? No. You probably wouldn't seek out this space. You know what you definitely wouldn't do if you were mobility impaired and you had an IV in your arm? You wouldn't play air hockey. 

So all of this good intention is in the AYA community, and yet we still haven't managed to create a space that's meeting this need. Even more importantly, you walk outside that room, and you're back on Sandcastle Court, and all of a sudden it's really apparent that you are not in a space that has even remotely been designed for you. And so how are you supposed to create a sense of healing when you don't even feel like anyone has been looking at how you heal in that space? 

My dissertation was a series of three studies. I'm only going to talk about two of them, and I'm going to talk about them pretty quickly. But the second of the studies-- the first one was a set of interviews trying to get to know the people that were actually using this space. That informed this survey. 

It went out to over 100 adolescents and young adults nationwide that had been treated for cancer, and the goal was to figure out actually how big this problem was. Is there actually, like it looks like, an inadequacy in the built environment, and how intense is that inadequacy? When you're talking to health care administrators, the people with money, the people that make design decisions, it's not enough to say, hey, we think there's a problem. They really like to see numbers. 

And so this is where all of you-- even though you come from all different colleges across Cornell-- need to not only be maybe interested in research, but at least prepared to disseminate research, because that's how you get money to solve some of these problems. So I wanted to know how big this problem actually was-- quantify it-- and then figure out if there really was a relationship between how we design an environment, and whether that affects our feelings of social support, and then our health-related quality of life. 

Health-related quality of life is kind of a big marker when we're talking about health care administration, getting insurance reimbursements. This is an outcome that people really, really care about, because you need to have decent quality of life scores to get the maximum insurance reimbursements if you are a health care system. 

So if we're able to say, hey, Fort Worth Cook Children's Hospital, I have a way to improve your health-related quality of life. Probably more likely that some money's going to be thrown at that problem. 

So the survey looked a little bit like this. Can you guys see this, or do you want me to turn the lights down up here? It looks good. OK, awesome. So the survey looked a little bit like this. There were a couple different parts. 

But I created a list of 22 characteristics that you might find in a hospital environment. And that ranged from anything like private bedrooms and private bathrooms, to things like entertainment, internet. And they were asked to not only say whether they thought those things were important, but also whether or not they felt they were effective in the place that they were treated in. 

And these two things together make a really compelling piece of information, because if something was effective, but you don't really think it's that important, then that's not really something that you need to spend a bunch of money on. If we say, for instance, that artwork was really effective-- sure, there was a bunch of artwork in our unit, but I don't really care about artwork-- then maybe artwork isn't the thing that we're going to spend the most money on. 

And so having these two elements together gives us a better picture of where the inadequacies are occurring. And they were occurring all over the place. Across every single environmental characteristic-- there were 22-- there was a significant statistical difference in the measure of importance and the measure of effectiveness. And again, some of these things were not quite as important, but they were all inadequate. 

The biggest ones were things like the private bedrooms, private bathrooms. Outdoor space was the most discrepant in terms of importance and effectiveness. Really hard to get outdoor space in oncology units for infection control reasons. 

And this is the end of the list, so this is characteristic number 22. This is characteristic number 21. And patient-only lounge comes up as characteristic 21 of 22-- which really threw me. 

It made me a little bit crazy, because here I was-- the entire thesis behind my dissertation was that young people really want to connect with their peers. We really need to create a space where they are interacting with other young people their age. And yet, here were 100 AYAs who said, we don't really care about a patient-only lounge. 

And so I wasn't really sure where to go to next. I remember where I was when I looked at these statistical results, and I was like, OK, that was my entire dissertation. And so I had to figure out what was happening here. Why is it that all of these young people-- in a different part of the survey, 86% of them said they wished they had had more interaction with another AYA cancer patient, and yet they don't want a patient-only lounge. So why is that? 

This helps explain it somewhat. So these are the results of a regression model. Essentially what we're doing here is trying to figure out the variables, the factors, that might predict health-related quality of life. What are the things that go into health-related quality of life? 

Well, I'll tell you one of the big things that goes into health-related quality of life-- is your actual health. So your actual clinical symptoms, your prognosis-- that is almost the entirety of health-related quality of life. And yet I hadn't measured anything clinical. 

So I was trying to figure out if maybe the built environment and feelings of social support could actually predict health-related quality of life in a meaningful way-- and it did, which is pretty cool. So what you're looking at here-- I don't know if I have a-- do I have a little laser on this? I do. 

So what you're looking at here-- health-related quality of life is a combination-- at least in part-- of the adequacy of the built environment, access to an AYA program. So it wasn't enough to say we'll build it. You actually had to have some programming elements in there as well, some nursing staff, some clinical staff that knows AYA patients. 

You had to be satisfied with the amount of interaction that you received, and your social support had to be good. I'll show you this number here-- right here. So the R squared number-- this is not a statistics class, and I apologize for those of you who have statistics training, because I'm going to boil this down. 

But the R squared number's essentially telling us how well these four variables are predicting health-related quality of life. And that adjusted number is 14%. So it's predicting 14% of the variance in quality of life. And you're like, 14%? That's really not that much. 

Remember that none of these are actual measures of health. And if you are the new proprietor of, maybe, let's say, the new HIV drug-- if you can find a 14% R squared value in terms of the efficacy of your new drug, that drug is going on the market tomorrow. And so here we have really crazy, cool evidence that the way that we design things and what we put in those spaces is actually affecting our health in a real clinical way. 

That's so wild for people who are interested in design, because I'm not a physician. I have no clinical training. And yet the decisions that I'm making are affecting people's physical health. 

Oh, and I was so excited-- but then I got back to this idea of the patient-only lounge, because how am I supposed to make recommendations for the correct design decisions? How am I supposed to correct the adequacy of the environment if I don't know what people want? And so why don't they want a patient-only lounge? I couldn't figure it out. 

And this was another part of the survey. I had asked people, OK, if your environment can afford something, if you can get something out of your environment, what is most important for you in your cancer treatment environment? At the bottom of this list was interaction with other patients. 

And so this isn't giving me any clues about what's going on at all. That led to the-- I'm going to skip over this one. That led me to the third part of my dissertation, and it was trying to figure out the nuances of how we actually design for social interaction. And this is kind of where there's a pretty important intersection with health and hospitality. 

Hotels do this pretty well. Hotels are designed for interaction, whether that's intimate interaction with another person, or whether it's group interaction or conference size interaction. We're pretty good at creating spaces that people can interact in different ways, and at different levels. But hospitals are not. And this is even more important for young people. 

This was the result of an interview that I'd done at the beginning of my dissertation, and it highlighted this issue pretty clearly. If you want to socialize-- you might want to, but you're having all sorts of body image issues, and you feel like you're violating someone's privacy by going and talking to them if you don't know them. And so how do we create social interaction if we have all of these barriers? 

I think it is a spectrum. I think that there is a really good opportunity for social interaction, but only if you also have a place for privacy. When we talk about privacy in environmental psychology-- so environmental psychology is what I do. When we talk about privacy, it's not actually social isolation. 

So you might think of privacy as being holed up in your room, and hanging out by yourself. But privacy is actually the balance between your desired social interaction and your achieved social interaction. If any of you have taken Gary Evans'-- I see some of you smiling, so that might look a little bit familiar to you. So you know that there is a spectrum of privacy that goes from isolation, all the way up through hanging out with people that you're close with. 

This is highlighted really well by the fact that the things that were most important for young people were things like autonomy, independence, privacy. How do we create an environment that gives someone those things so that they then feel empowered to seek out social interaction? This is a little bit of what I think it looks like. 

From our inner selves, autonomy is a sense of behavioral control-- that you want to be able to do what you want. Barriers to this are sometimes, actually, shared spaces. Shared spaces have kind of weird rules to them. 

If you can picture, maybe, your freshman dorm room, and maybe you had a suite, you had an open, shared area-- that had very different rules than your own private room. And then if you went into the common lounge on the floor, that also had super, super weird rules that maybe were kind of hard to figure out. 

Are you allowed to play music out loud? Are you allowed to lay your entire body out on the couch? Are you expected to be totally quiet? And so those are the things that, in their own unconscious way, act on your behavior. 

It moves all the way through independence, territoriality, and privacy. Independence is our physical control-- can you actually navigate through a space? The big one with that is mobility impairment, but also wayfinding. Have we given you a good idea of how you get through space? 

Territoriality-- I'm sure this is kind of exactly what you guys think it is. Animals create a sense of territory. How do we allow patients to create a sense of territory in a space that is not their own? That takes time. 

You have to be in a space long enough to create a sense of territory. But you can also create it by doing things like bringing in personal items, bringing in your own blanket, bringing in photos from home, a plant. All of those come with their own infection control challenges, but we need to create a space where you have your own territory. 

So study number 3-- I'm going to go through pretty quickly, but this one's pretty cool, because I think there's some tools from this research that might apply to a lot of you in different disciplines. I created a set of focus groups. And these weren't the traditional focus groups that you picture when one person sits down in a room with a bunch of other people, and they talk, because I didn't think that was going to work. 

I needed perspectives from people across the country, people who had different experiences with a bunch of different facilities. If the only thing that you guys knew was Cornell University and I asked you how to design a university, you would give me ideas that were really only coming from your own experience with this one school. And so I needed to talk to people who had experience with a bunch of different health care systems. 

Talked to them, did a little, mini interview, and then we did a couple tasks where they were asked, if you were on the design team for a new facility for people your age, how would you do it? Show you a little bit about what that looked like. So this was the first task. 

They were given that same list of 22 characteristics from the survey and asked, OK, you're in the design room. You get to tell architects and interior designers what to build. There are things that you must have. There are things that you should have, if you have a decent budget. And there are some things that you could have, but you could also do without. 

So distribute these 22 characteristics evenly, and tell me that with our limited budget, what are the most important things for you to have? I'm sure you can picture, maybe, some ways that this tool could be really useful for you, even in UX research. Doesn't mean you have to look at a really large space. And this is what we found. 

Private bedrooms, private bathrooms, visitor beds in patient rooms, and family/patient lounge-- all of those suggest that there is this spectrum of privacy to social interaction that people are after. You know what was at the very bottom of this list? Patient-only lounges. 

So here's just more confirmation that it's not actually creating a space for young people to go to and hang out together in this weird, awkward way. It's creating a space where you have enough privacy, enough opportunity to regulate your own space, that you eventually want to go out and meet people, maybe a little more informally. 

And then I did a third task. It was a photo evaluation task. So I had four areas. I had a lounge area, meditation space, outdoor space, and a bedroom. And I had photos. And none of them were clinical, so none of these looked like hospitals, and that was the intention. 

And I said, OK, of these nine photos, pick three that you would show to the design team as inspiration for what you might want a place to look like. And my hypothesis here, what I was thinking was going to happen, was that young people were going to say, we really want spaces that have a sense of privacy, that have this hierarchy of being able to conceal yourself, and kind of go out when you're ready. And that was kind of true, but not totally what happened. 

So number 6 here-- number 6 and number 7 and number 1 all have something pretty similar going on. Can any of you see what that might be? The seating is really important here. 

And so I'm doing these interviews-- I did three focus groups. So across this it was about 16 participants. And I'm thinking, oh, wow. We're going to have this awesome conversation about privacy and regulation and how you're sitting. And all we talked about was the comfort of the seating. 

And so I, again, had this moment, even in these interviews, where I'm panicking. Especially during the first focus group, I was like, oh, no. We're supposed to be talking about privacy, and now we're just talking about chairs. And that actually ended up revealing a pretty important part-- that even though there are these psychological processes going on when we're in a space, there are some things that trump that. 

If the chairs aren't comfy in the first place, you can design a really cool space, and no one's going to go in it, because comfort is more important. We see this again in the patient bedroom. So I was anticipating that people were going to be really stoked about photo number 2, because there's this curtain. And I thought we were going to have a great conversation about maybe the curtain allowing you to regulate your privacy. Nope. 

We talked about number 5, because there was a visitor bed. We talked about number 6, because it looked cozy, and there were places for you to put your own belongings-- remember that sense of territory? And number 9, because again, there was this sense of homeyness that was created in these rooms. We did not talk about privacy at all. 

In the outdoor space, something comes up. We're talking a little bit less about comfort here-- although clearly the places with the wooden benches were not very popular. We're talking less about comfort and a lot more about something called positive distraction-- what you might be able to do in a space that transports you away from the burden of being in a hospital, or in a health facility. 

Number 3 and number 5 and number 8 all have elements of positive distraction in their own ways. Number 3 has this maze that allows you to do something else-- because beautiful hospital gardens are awesome, but if you're just sitting there-- you're still getting benefits, but not necessarily this element of positive distraction that could be really salient. 

Number 5 was popular because of the cushions-- and the color. And number 8 was popular because of this city view. And this isn't necessarily something that is appropriate to implement in a hospital. It's going to be really rare that you can even design a rooftop garden with a beautiful city view on a canal like that. But what's important, there, to note is that there is something else that is transporting you away from the experience. There is the opportunity to see something other than the hospital. 

And the meditation room-- so this was any room that you might go to alone, or maybe with one or two other people to find respite. What do you see in-- what initially stands out to you in these photos? Anything in particular? 

If you were going to pick one that really stood out, why did it stand out? You can just shout it. Yeah, nature. So that big, green wall is probably what caught your eye initially in this entire thing. We spent most of the focus group talking about the big, green wall-- which is awesome. 

Number 2 has the natural elements as well-- the sense of an open door, an intermediary between nature and indoor space. So I said, why not number 4? Number 4 has this water feature. And everyone said, yeah, we really like the water feature, but the chair looks really uncomfortable, so I'm not going in there. 

So here it is again. I'm creating, as I'm going through these focus groups, these hypotheses, and they're just being shut down. And comfort and positive distraction are really coming out as particularly important. So not only do we have to provide social support, but we also have to provide choice and control, positive distraction, and comfort. 

It's not enough to build a space for social interaction. It has to provide a hierarchy of social support, positive distraction, and comfort-- I'm looking at my time. I have to go quickly. So some ways that you can do this-- these are guidelines that are in some ways well-researched, and in other ways need a lot more attention. 

These are also guidelines that you can take, and potentially apply to places that aren't oncology facilities. There are a lot of other places we treat adolescents and young adults for large amounts of time-- mental and behavioral health centers, some parts of the criminal justice system. Thinking about how to design a hotel for an adolescent and young adult population would be a fascinating thought experiment. 

But you'd have to do some of these exact same things-- create a space for families and patients to interact together, both inside and outside the room. You'll see little green arrows or little green triangles, orange squares, and gray circles. It's indicating how much evidence we have for these things-- not just from my own study, but from existing literature. 

We know that young people need their families, and need space to interact with their families. So we have to provide that for them. But perhaps if we create a larger distance between things-- between the patient room, the kitchen, maybe the common area, the clinical areas-- maybe you're more likely to run into someone your own age. In that big survey, I asked young people where they often met people their own age in the hospital, and almost all of them said the hallways. 

So how do we create a hallway space that might function as a social environment? Well, first you have to get people in the hallways. And that means putting things a little bit farther apart than they might otherwise be. 

None of these things have a ton of research associated with them. Some of them are pretty common sense, so I think they're pretty solid design guidelines. But others aren't. There, particularly from this dissertation research, wasn't a ton of evidence that we need a patient-only lounge area. That didn't seem to be a totally popular idea. And yet that's something that's present in these nine facilities across the US that have attempted to tackle this problem. 

What if there's a way that we can set up cooperative recreation-- that if someone's doing something, you want to join in? In a lot of these AYA areas, it's video games. And I think, for some of you, you'd be like, all right, cool. Someone's playing the Witcher 3, I want to watch. I'll join in. And I think for some of you, you'd be like, I don't really want to sit down and do that with someone. 

So we need to think of other ways that you might invite someone else to come do the activity that you're doing if you don't know them. And then artifact evidence-- this one's a little bit more "designer-y." But how can we create a space that maybe you got a sense of the people that have come before you, and from that you get a sense of social support? 

So how do we maybe give you a whiteboard that you can leave messages for someone else who comes through the room next? Choice and control-- this sense of hierarchy from public to private space. Create rooms that aren't just private, but also maybe semi-private, semi-public, and public, so you have a choice of how much interaction you're getting. 

Also, providing seating choice-- and comfortable seating. And then providing control through things like lighting and temperature. This doesn't have to be totally revamping the HVAC system in your facility. It can just be providing a bedside lamp that has a dimmer, or providing a chair that has a heating element to it. 

Outdoor space-- this is a pretty particular one in terms of oncology-specific issues, because there's a lot of cancer treatment that makes you pretty sun-sensitive. How do we create a space that transports you away from the hospital without you being exposed to sun? I think there's a really compelling potential research direction here in looking at that. 

Artwork-- I talked about artwork really briefly when I was introducing this. Artwork's kind of tough. We know, from a lot of studies-- including one done by our very own Mardelle-- that there are different preferences for artwork as you go through the lifespan. But overall, we're looking at things that are a little bit less abstract, and a little bit more nature-oriented. 

Comfort-- this is the one that I actually hope you take away the most from as you go out into your various careers. You got to design a comfortable place. But also, if you look at the places that have been designed for young people right now, it's things like blues and oranges and the Avengers and video games. And it just feels like a bunch of older people have thought about what it's like to be a teenager, and then built a space. 

And that's exactly why we need to ask people what's important to them, because then we end up with spaces that actually look homey, and not like they were-- almost even worse-- tried to be designed for, and it just wasn't successful. For those of you who've been in Gary's class, I will make an aside that what we know about making something home-like-- most of the research has been done in North America. 

And so another really important research direction is how we look at the cultural differences, and what makes something feel like a home. And how do you provide that for people who are coming-- let's think about Johns Hopkins. People come from all over the world to be treated there. And so how do you create a home for people that have a very different sense of what it's like to be in a home? 

Really cool research direction there. And I will actually wrap up on that so that we can chat. If any of the rest of the slides seem relevant to some of the questions, I'll bring them up, and we can talk more about it. 

[APPLAUSE] 

MARDELLE MCCUSKEY SHEPLEY: OK, these are the questions that students sent in. Some of them you've answered already. 

KATI PEDITTO: Awesome. 

MARDELLE MCCUSKEY SHEPLEY: So I will try and pick those that you haven't. Is there something in the room-- some question that's really pressing, particularly in regard to understanding the content of the material that was presented? 

AUDIENCE: I have a question. 

KATI PEDITTO: Yeah. 

AUDIENCE: So these children's hospitals housing some of these unique patients, being older-- have they taken initiative to make more individualized patient surveys for the type of patients that better understanding their needs and how they feel when they interact with a pediatric hospital? 

KATI PEDITTO: Yeah, I would have loved to break this survey down even more to look at the differences between people who might be in that older adult age, especially if you have kids. Age 39, you might have a family at this point, versus the needs of someone who's maybe 15 or younger. It's not something I've done yet, but it would be a really important next step in terms of creating those transitions across ages 15 to 39. Is that what you asked? 

AUDIENCE: Yeah. I mean, I was trying to get at, like, when you go to a hospital, they give you this patient survey-- 

KATI PEDITTO: Right. 

AUDIENCE: --the hospital actually providing more individualized surveys, both so that the patients have AYA programs where they kind of advocate for hospitals that adapt that. 

KATI PEDITTO: I would love to see that happen. We have a couple champions across the physician network that work with AYAs. It's really hard to get some of these surveys through the hospital review boards. It's hard to do research in hospitals. And so the next step of this is absolutely actually getting feedback from people who have been in that space very recently. 

MARDELLE MCCUSKEY SHEPLEY: OK, thank you. So here are two other questions. One of them is, how can we, as students, help improve the health care environment, especially in regards to vulnerable populations? Do you recall who you are? 

KATI PEDITTO: That's a great question. I would love to give you credit for that. Awesome. [SIGHS] But one of the first steps to this is actually figuring out how to include those vulnerable populations in the design process. 

That last study that involved the focus groups-- those were participatory design workshops including people in the design process, whether that's adolescents and young adults, whether that's veterans in an acute behavioral health center, whether that's young people in the criminal justice system. Providing them an opportunity to create and own the space that they are in-- that's a social justice issue. And so, as designers-- or as researchers-- it's important to create tools and methods that involve people in the design process. 

MARDELLE MCCUSKEY SHEPLEY: Next question-- what career advice would you give to someone who's interested in health care design? 

KATI PEDITTO: Ooh, interesting. [LAUGHS] 

MARDELLE MCCUSKEY SHEPLEY: Who does that belong? Back there. 

KATI PEDITTO: Awesome. So my path was a little bit untraditional. As Mardelle mentioned, I came from psychology and then went into the doctoral program here in human behavior and design. So I had the human behavior part, but I didn't have the design part. 

I sketched that. And that's the culmination of my design expertise. [LAUGHS] Mardelle was very proud, because I had actually done a design exercise with this. 

So I think what's pretty cool about health care design is that people are coming at it from different angles. We need environmental psychologists to inform, translate, and disseminate this research. We also need people with the actual visual communication, architectural design skills, to implement these things. 

So I'm quite biased about our program in DEA. We have a minor in DEA. There's also the minor in the Institute for Healthy Futures. So getting that interdisciplinary exposure is the most important part to being a good health care designer. 

MARDELLE MCCUSKEY SHEPLEY: Would you ever consider moving beyond the field of research work on the other side as an employee of a hospital or design consulting agency-- 

KATI PEDITTO: Did you write that? 

[LAUGHTER] 

MARDELLE MCCUSKEY SHEPLEY: I did not write that. 

[LAUGHTER] 

Who wrote that? 

KATI PEDITTO: Awesome. So that's a very fair question, and one that I'm actually grappling with myself right now. I'm in the middle of the job search. And I've been in academia my entire life. I went from undergrad, to PhD, finished that. And I stuck around with Mardelle for a little bit longer as a postdoc. 

I love teaching, so that's part of the thing that's keeping me in academia. But there is an argument to be made that there need to be people out there who understand research who are working at the practitioner side, people who are working for the firms that are actually implementing these things. 

I think next week, or the week after, you guys are going to hear from Lynne Rizk from HKS. She's a great example of someone who understands research and then, consequently, how to implement it. You can make a pretty big change at that level. So there is a part of me that is called to that, as well. 

MARDELLE MCCUSKEY SHEPLEY: There are a couple question that relate to the particular cancer diagnosis. And I guess they both sort of suggest that, does the type of cancer you have influence the type of environment you might receive? 

KATI PEDITTO: Oh, sure. So there is some evidence that even the acuity-- so the seriousness-- of your disease affects the quality of life during those experiences. One of the big things that we talk about in design for oncology spaces, specifically, is whether you are immune compromised. So there are a number of different diagnoses that require you to have a bone marrow transplant or a blood transfusion. And those are intense. 

You are put in isolation for up to three months. How do you create a space and create a sense of social support when you're in isolation for three months? It's not something I've explored, but it's something that came up in a lot of the interviews and some of the open-ended questions on the survey. We need people looking at that. 

MARDELLE MCCUSKEY SHEPLEY: And what do you think is the next step? How do you share your information? How do you change the world, based on what you've done already? How are you going to use that to change the world? 

KATI PEDITTO: The first step is doing stuff like this-- sharing what I've learned, trying to get this out of the ivory tower of Cornell University and into the hands of people who can actually make a difference with it. So disseminating it is the first really big step. Part of that is the variables that I chose. I chose variables that people care about in the health care industry side. This is research that can be presented to health care officials in a way that kind of makes sense, financially. 

And then talking to people in architecture firms-- this gets back to our original question earlier about whether I feel called to the other side. People that are on the other side are the people that are going to make a difference with this research. And so making sure that this gets to them is important as well. 

MARDELLE MCCUSKEY SHEPLEY: We have time for one more question. Yeah, go ahead. 

AUDIENCE: Thank you so much. I really enjoyed the presentation. I'm Adam Shapiro. I am a senior in the Patel school. And I wrote this question down. I submitted it above the VA, because I was looking at some of your case studies online. And I've always been pretty curious just to learn more about that model. 

And specifically, it just seems like the Veterans Affairs-- and the VA, specifically-- they're backing a lot of funds already. And more recently, the past few years, there's been a lot of headlines around mismanagement, and also just shortages of wait times and doctors. And so I'm just wondering, how is it that the government and politicians will support improving the design before improving more of the bring you pizza and the ignore the structural issues? 

KATI PEDITTO: Yeah. So Adam asked a question about another study that I was involved with-- that Mardelle was involved with, as well. We looked at a patient room mock-up. So a couple people from a design firm had come in, and they actually built a patient room at a VA hospital-- a Veterans administration hospital-- in New Jersey. And we had-- again, as an example of involving vulnerable people in the design process-- we had both patients and staff walk through this mock-up and tell us a little bit about their experiences in it before we designed an entire facility that looked like this. 

And Adam was wondering whether, given this mismanagement of funds, the lack of available funds, how do we actually make a case for the importance of design in these situations? And it's exactly that regression model-- we need research, and that wasn't necessarily revealed in the context of this one case study. But we need research that is linking the built environment and actual health outcomes that have financial incentives, especially for the government. 

It's hard to make a case that it would be more important than providing more counselors, more acute care. I think those are the things that need to be in place first. That regression model also had AYA program in it. It's not enough to design the space. You have to have the resources to support it. So if the resources aren't there, it would be hard to make a case to build a space. 

MARDELLE MCCUSKEY SHEPLEY: Great. I think that's the end of our time allocation. So thank you. 

KATI PEDITTO: Thanks. 

[APPLAUSE]