Color scheme: Implementation Evidence-Based Design for Palliative Care and Hospice Building

The number of patients suffering from cancer has increased 27.8% per 1000 population from 2013 to 2018 and most of cancer patients come from Jakarta. Based on interviews with health workers and cancer patients, it can be concluded that there are problems in terms of space requirements and space design in current palliative care and hospice care facilities. This study uses a qualitative method. The data used for this study came from interviews as part of the Evidence-based Design (EBD) process, which was then analyzed using coding techniques and precedent analysis to draw conclusions. It was found that color is an element that can influence human health, the preference for color by cancer patients in Indonesia is in line with the color preference for hospice buildings and cancer health facilities in western countries, and it was also found that cancer patients need a communal area, consultation area, therapy area, spiritual area, and in-patient area. Each of these areas requires a different color scheme.


Introduction
Efforts to understand the impact of the environment on healthcare outcomes have grown rapidly in recent years.The Evidence-Based Design (EBD) approach in the design process allows practitioners to find solutions to the relationship between humans and the environment [1].Research proves significant results when the concept of Evidence-Based Design (EBD) is applied to health-based buildings [2].In architecture, practitioners who design health buildings have developed design ideas based on research results regarding the relationship between architectural design and health [3], involving nursing professionals, family, friends, and even patient experience to create spaces that are able to provide patient comfort when passing through the treatment process becomes a discourse in the architectural design process.need to take a holistic approach that combines evidence, professional experience, and personal attention to van der's situational context [4].Implementation of Evidence-Based Design (EBD) is a new way to improve healthcare by focusing on the user [5].
Although EBD is quite interesting to implement, practitioners need to realize that EBD is not a rejection of creativity, but a means to improve solutions and the quality of their designs [6], the literature shows that information regarding how to integrate EBD into the design process phase requires certain strategies [7] Recent research proves to produce a quality design that is important for combining EBD with traditional design processes [8].

Research Problem and Methodology
Regarding buildings, evidence-based building aims to improve care in the final phase of life, architectural and landscape design considerations, arrival halls, communal and private spaces, transition spaces, and natural connectivity are things that need to be considered properly in Hospice and Palliative Care buildings [9].research conducted in Africa, the application of EBD in Hospice and Palliative Care buildings shows that it needs to be accompanied by the right policies, it is not appropriate if design ideas in buildings in western countries are applied in Africa [10].The problem in this research is how to design the right Hospice and Palliative Care building in accordance with the character of Indonesian society, especially for patients with cancer.
This study aims to understand important information related to evidence from patients and patient expectations in the treatment process carried out, research with a qualitative descriptive method through in-depth interviews with several patients, and health practitioners are important.The analysis is carried out using coding which is transformed in the form of space and spatial quality, especially in terms of color.

Palliative Care and Hospice
Research conducted in Indonesia proves that the number of patients suffering from incurable diseases (terminal diseases) such as cancer has increased [11].Riskedas (Basic Health Research, Ministry of Health of the Republic of Indonesia) data shows an increase from 1.4% per 1000 population in 2013 to 1.79% per 1000 population in 2018 is an increase in cancer sufferers [12] and most cancer patients come from Jakarta [13].Dharmais Cancer Hospital was once one of the domiciles of the most cancer patients who underwent treatment [14].
Palliative care to reduce suffering, extend life, improve quality of life, and provide support to patients with terminal illness and the patient's family is the goal of palliative care.Palliative care is integrated care carried out by doctors, nurses, social workers, spiritual counselors, and other needed professionals [15].Palliative care will continue after the departure of patients with illness, namely by focusing on providing support for the families left behind [16].Decree of the Minister of Health of the Republic of Indonesia 812/Menkes/SK/VII/2007 concerning Palliative Care Policy states that there are seven types of palliative care activities, including pain management, management of other physical complaints, nursing care, psychological support, social support, cultural and spiritual support, support in preparation for and during times of grief.Hospice care is not much different from palliative care.Hospice care aims to reduce suffering, improve quality of life and provide support to patients with terminal illnesses and their families [17].What distinguishes hospice care from palliative care is that it is available for patients who have six months or less to live [17].

Evidence-Based Design (EBD)
Evidence-Based Design (EBD) is a process of basing decisions about the built environment on research that has been conducted to achieve the best results according to needs [18] and produce a built environment that helps the healing and recovery process more effectively for patients and related staff (healing environment) [19] Data that will be used in Evidence-Based Design (EBD) can be obtained by conducting literature studies or interviews [19], namely as the latest evidence to produce designs that meet current needs.The Centre for Health Design (CHD) research topics related to the relationship between Evidence-Based Design (EBD) and patient conditions.It can be concluded that Evidence-Based Design (EBD) has a great correlation with reducing stress and improving the quality of life and healing of patients and their families, so Evidence-Based Design (EBD) is considered suitable for designing facilities that aim to reduce stress, improve quality of life and healing of patients and their families [18].

Color: Curative Intervention
Color is is an element of light which is a spectrum of electromagnetic waves reflected by an object and then interpreted by the eye based on the light that hits the object.It is believed that colors have certain perceptions and meanings that are different according to each individual and culture [20].Research has shown that color has potential as a healing and recovery agent for trauma, depression, physical illness [21].Color can also be used as a curative intervention in overcoming certain unwanted emotional or psychological states [22].The emotional strength of colors has implications for mental health and has the potential to shape moods [23].Even though its effectiveness is still under long debate in the medical community, it is quite reasonable if color therapy can be used as a complement in improving the mental condition of patients in hospitals and health centres [24].

Research Results
This research is part of the final assignment project process in the field of architecture with the original title "Hospice with Evidence-Based Design Approach in North Jakarta".Data collection was carried out by interviewing three health workers, as well as three cancer patients and their families.

Space Needed: Interview Data Processing
This is the response to the space needed.Based on the classification of patient statements, followed by responding to space needed based on patient statements.The response to space requirements will be described in Table 2. (ComA = communal area, TA = therapy area, GA = garden area, SA = spiritual area, CA = consultation area, IA = in-patient area).The statements included in table 1 have been curated to obtain results that are in accordance with the classification objectives (AL = health workers, VD = health workers, RS = cancer patients and families, I = cancer patients and families, R = cancer patients and families).In the hospital, the place is limited What is certain is that I want a hospital with a homelike atmosphere ✔ ✔

R
The facilities are also so that they don't look like a hospital, because they are already stressed with their illness, so they feel more comfortable during the treatment period.The response of this color element was chosen because color has a direct impact on the psychological comfort of cancer patients and will be reflected in the patient's sensory and muscular senses [25].Color analysis is taken from hospice buildings and cancer health facilities.Based on Table 2, each space requirement requires a specific color scheme for cancer patients.It was found that for communal areas, analogous color schemes tend to be used, for therapy and consultation areas tend to use complimentary color schemes, while for spiritual areas the color scheme used is monochrome, and finally, the color scheme used for in-patient areas is analogous.Research has proven that human mood and health can be influenced by color [26] and that color schemes are not limited by cultural and cultural differences [27].So the color choices in some hospice buildings and cancer health facilities in western countries have the potential to have the same preferences as in Asia.

Analysis and Design Discussion
Based on the interview results, it was found that cancer patients need a communal area, consultation area, therapy area, spiritual area, and in-patient area.Based on precedent analysis, each of these areas requires a different color scheme.The color scheme for the communal area is an analogous color scheme, for consultation and therapy areas is a complimentary color scheme, the spiritual area is a monochrome color scheme, and for the in-patient area is an analogous color scheme.

Communal Area
Day Care is a patient activity area, which consists of a consultation room, common area, and therapy areas.Day Care is designed to be presented so that patients can enjoy care, socialize with fellow patients and nurses, and have a direct view of green areas to give patients a natural impression.This area is designed using an analogous color scheme, applied using white, brown, and green.A typical floor common area is a communal area intended for inpatients and families to socialize while enjoying the outdoor area.This communal area is presented so that inpatients at this hospice do not feel isolated in their unit rooms.The color scheme that appears in this communal area is white, brown and gray which can be categorized as an analogous color scheme.This analogous color scheme was chosen based on the patient's desire/need for a room design that is warmer and less institutional.This is proven by the patient's statements in the interview, such as "it really feels like a hospital", "it feels really cold" and "anything that has a natural and warm feel".Apart from that, this also proves that the use of analogous colors is also in line with precedent studies (Table 2).

Consultation and Therapy Area
The consultation room is presented as a forum for patient consultation with doctors, as well as psychologists.The consulting room is designed to have an opening to the outside to eliminate the institutional impression that generally exists in health facility buildings.There are ten consulting rooms at this hospice.This room is divided into two, namely five rooms for doctor consultations, and five rooms for consultations with psychologists.This is done because the scope of palliative care itself includes physical health care and also the psychology of the patient.Art therapy is a treatment offered in daycare, to provide emotional support to patients through art.In this hospice building, the art therapy room provides facilities for the art of painting.There are two art therapy rooms at this hospice, namely on the ground floor and on the second floor, with openings leading to the outside of the building.The color scheme that appears in this consultation and therapy area is white, brown, gray and blue which can be categorized as a complimentary color scheme.This complimentary color scheme was chosen based on the patient's wishes/needs for a room design that does not look like a consultation room which is generally found in hospitals "The facilities are not to look like a hospital, because they are already stressed by their illness, so they feel more comfortable during the treatment period".Apart from that, this also proves that the use of complimentary colors is also in line with precedent studies (table 2).

Spiritual Area
The meditation room in the hospice building is provided to meet the spiritual needs of cancer patients.Meeting the patient's spiritual needs is also the scope of palliative care and hospice care provided.The meditation room is designed using a monochrome color scheme that are white, chocolate, and grey as a response to "The facilities are not to look like a hospital, because they are already stressed by their illness, so they feel more comfortable during the treatment period" patient's statement.Apart from that, this also proves that the use of monochrome colors is also in line with precedent studies (table 2).The meditation room in the hospice building is designed with a capacity of 16 people for one spiritual activity.There are a total of 107 patient room units in this hospice building.The patient room unit is designed to accommodate the presence of the family so that the patient always gets emotional and social support from loved ones.The size of the patient room is 40.5 m2, with built-in folding beds in the cupboard.The color scheme that appears in this In-patient area is white, green, gray and brown, namely an analogous color scheme.This analogous color scheme was chosen based on the patient's desire/need for a room design that has a warm and natural feel.This is proven by the patient's statements in the interview, such as "anything that has a natural and warm feel".This also proves that the use of analogous colors is also in line with precedent studies (table 2).The green area is presented to patients as a place to feel a natural atmosphere so that patients are not stressed.The green area in the hospice building is located on three levels, namely the green open space on the ground floor, the second-floor roof, and the third-floor roof.

Conclusion
The conclusion can be explained in four points, first, color is an element that can influence human health.Second, the preference for color by cancer patients in Indonesia is in line with the color preference for hospice buildings and cancer health facilities in Western countries.Third, it was found that cancer patients need a communal area, consultation area, therapy area, spiritual area, and in-patient area to carry out effective palliative and hospice care, to obtain maximum treatment results.Each of these areas requires a different color scheme.As a research suggestion, further research is needed to see the percentage reduction in cancer patients' stress levels that are influenced by specific color schemes, because this research was only carried out at the analysis and color selection stage.

Figure 1 .
Figure 1.Palliative Care's Place in the Courses of Illness[16]