Design for the end of life asks for an integrative approach, in which (relatives of) the terminally ill patient, religious experts, medical staff, designers and philosophers all play an important role. Finally, all involved only aim to provide their patient, family member or friend with “What really matters at the end of life” (B.J. Miller, 2015).

Heartbead graduation project. Image retrieved from TU Delft.

Design has the capability to enhance the quality of life and improve health care from a different perspective. It is always the intention of medical professionals to cure diseases, but in some cases this is impossible. Thereby it also becomes increasingly important to design for the end of life and support people towards a worthy end. At the TU Delft the efforts in this topic are focussed on palliative and hospice care. Palliative care specializes in maintaining the quality of life for patients with life-limiting diseases. Hospice care guides patients towards the end of their life.

Palliative and hospice care consist of four different aspects. The physical aspect is the foundation of the care; to ensure that the patient is not suffering, feels as comfortable as possible and has no pain. The emotional aspect deals with anxiety, depressions, anger and other emotions. The social aspect addresses the people around the patient and the evolvement of the patient’s social life. The spiritual aspects deals with questions like “What did my life mean to me?” and “What is the meaning of life?”.

How can design be of value in palliative and hospice care? An obvious answer is by improving the physical comfort of patients. Design of the beds, rooms and the products they use can have a tremendous impact on their emotional well-being. Two concepts which illustrates that a product could improve the wellbeing of the patient are the “Mobile care seat for elderly in the last stage of their lives” (D. Unsal, 2012) and the “Long-stay support for immobile people in nursing homes” (Y.F. Chow, 2011).

The emotional design aspect plays an important role in providing direct solutions for the mental state of the patient. Digital companions like for example a robot dog can fulfill a social function and solve feelings of loneliness or isolation (J. Howard, 2017).  However, emotional design can also aim to indirectly address the patient’s wellbeing by helping to provide good care, so patients and relatives can feel trusted by the caregiver. An example is Pallas, this product helps caregivers to deal with the issues and challenges of their demanding job (S.W. Klok, 2014). Thereby design can play a role in optimizing (administrative) processes in palliative care, helping nurses and doctors to provide more personalised care.

Lastly, an important aspect in end of life is spirituality. By developing tools and products, design can play a role in facilitating conversations about spirituality; helping patients to find peace of mind. Providing a (neutral) place for prayer and respect traditions such as specific food or handling of a body after passing away, is also of great importance. Design can help healthcare professionals to take into account different religions and their beliefs in matters of terminal care. For example, before making a final decision for a muslim patient it might be important to not only consult the relatives, but to also include spiritual counsel by an ethicist or Islamic scholar.

Conversations about end-of-life are a sensitive topic that touches upon the core of each culture. In recent years, especially in the Western world the discussion about the topic is opening up. As we approach this sensitive topic we must be careful not to step on each others toes. It is important to include people from all different disciplines in this discussion, to help think beyond healthcare or design. Design for the end of life asks for an integrative approach, in which (relatives of) the terminally ill patient, religious experts, medical staff, designers and philosophers all play an important role. Finally, all involved only aim to provide their patient, family member or friend with “What really matters at the end of life” (B.J. Miller, 2015).

Social/cultural aspects present a design opportunity for products and services to help raise awareness and empathy towards mental health sufferers, as well as helping patients to build the confidence and skills required to become independent members of society.

Design for Psychiatry. Image retrieved from ID Studio Lab.

Health psychology studies the psychological and behavioural processes in health and mental illness in the healthcare industry. Health psychology has the biggest impact across the human lifespan in the healthcare industry. A health psychologist sees an illness as not only a result of biological processes but a multitude of external factors, namely psychological (thoughts and beliefs), behavioural (habits) and social processes (socioeconomic status and ethnicity). This is called a biopsychosocial approach; the whole person is treated and not just the physical symptoms (Ogden, 2012). Jeroen Deenik (J. Deenik, personal communication, 23 October 2017), found that this approach is also needed in psychiatric long-term care hospitals. He proved that change of lifestyle, especially behaviour, was beneficial in the treatment of these patients.

First, what is psychiatry? Psychiatry studies and treats mental disorders, which often has roots in emotional imbalances and abnormal behaviours (Merriam-Webster, 2017). Biology plays a large role not only as a trigger but also in the complications associated with living with a mental disorder. In the most extreme cases of psychotic disorders, movement disorders are the largest challenge facing this population. Because of the medication patients are dying 20-30 years earlier due to cardiovascular disease, metabolic syndrome and diabetes, all attributed to avoidable risk factors such as obesity, high blood pressure, bad cholesterol levels and inactivity.

The social/cultural aspects of mental health care also influence many aspects of mental illness including how patients express their symptoms, their coping methods, family and community supports, what types of help they seek and willingness to seek treatment altogether (The Influence of Culture and Society on Mental Health, 2001). Likewise, the cultures of the clinician and the service system influence diagnosis, treatment, and service delivery. For example, pill-taking for mental health issues is normalized in some cultures, while in others it is seen as a sign of weakness. These cultural/societal differences need to be considered when designing for the mental health care industry.

Deenik (2017), explains that the culture within Dutch long-term care facilities used to be about making it as comfortable as possible for these patients. Before no regimes where in place to support healthy living within the facilities. Furthermore, the social stigma associated with mental health is still a major problem. Mental health patients consistently identify stigma, discrimination and social exclusion as major barriers to their health, well-being and quality of life (The National Mental Health Stigma Reduction Partnership, July 2013). Deenik (2017), has very effectively implemented behavioural and cultural/social changes within a psychiatric hospital. Overall patients improved on their physical activity, metabolic health, quality of life and psychosocial functioning. Besides, it reduced the overall use of medication.

Current interventions did not involve design, therefore there lies a great opportunity for innovation and improvement in designing for psychiatry. Designing interventions to address the health risks is complex as there are significant interrelations between the mental illness, the medication, interpersonal and intrapersonal relationships. Opportunities exist in motivational programs for staff and patients, innovative technology to enhance the environment or patient care, as well as designing systems for continuous care (Deenik, 2017). Social/cultural aspects present a design opportunity for products and services to help raise awareness and empathy towards mental health sufferers, as well as helping patients to build the confidence and skills required to become independent members of society. Examples can be taken from patient empowerment design projects on, for instance, behaviour tracking and goal setting apps, interventions in communication between healthcare professionals and professions etc. Most likely, however, a more tailored design is needed for the psychiatric hospital context.

3D imaging software has made it possible to take multiplf images and stack them into a digital model. Using the parameters of computed tomography (CT), magnetic resonance imaging (MRI) or positron emission tomography (PET) scans (water density / traces of radiation) designers can isolate organs, structures and even tumors. The result is a CAD model which can be used by professionals for personalized designs and to take measurements of the body.

3D Handscanner. Image retrieved from TU Delft.

Medical imaging is used to facilitate visualization of diseases, organs and other parts of the human (or animal) body. Traditionally, scans consist in sets of 2 dimensional planes that help physicians understand whatever is inside the body. It is not possible to obtain depth in a 2-dimensional image. Therefore, a set of pictures are made following a straight line (axis). Scans can use sound frequencies (Ultrasound), radiation (CT) or magnetism (MRI) and depending on that visualize bone structures, tissues, organs, tumors, etc.

3D imaging software has made it possible to take this group of images and stack them into a digital model. Using the parameters of CT, MRI or PET scans (water density / traces of radiation) designers can isolate organs, structures and even tumors. The result is a CAD model which can be used by professionals for personalized designs and to take measurements of the body.

In addition to 3D scans, some devices can stack together 3D images taken in a short period of time. The outcome is a digital animation where the viewer can see how the scanned object changes over a certain period of time. Examples of the use of these so called 4D scans in a medical context are 4D ultrasounds during a pregnancy check-up or the visualization of specific organ functions (e.g. blood oxygenation and pump).

This is a major improvement compared to the plane image scanning and it generates new areas of opportunities where the medical and design community can work together to help patients in a better way.

• Having 3D and 4D models can be a tool for medical students to get meaningful training before a real practice. This is especially interesting when paired up with virtual reality environments and interactions. It also reduces the need of bodies for dissection.
• Scans can be 3D printed in order to prepare doctors, before a long invasive surgery.
• Designers can work with specific measurements of a specific user / set of users (e.g. medical applications for newborn babies).
• 3D models of people involved with accidents or deformations can be used to print suitable prosthetics for the healing process. In addition to this, the research of new materials (e.g. biomaterials) is used to print functional organs for patients in need of a transplant.
• Insitum scans with the actual patients has been used as a first step to print tissue over wounds and regenerate skin.
• Create data sets and libraries for further research and development in the fields of medicine and design. With the democratization of 3D printing, developing countries and enthusiasts can get involved with the design of products like casts and prosthetics.

These 3D processes that visualize the inside of the human body are a considerable upgrade from the flat 2-dimensional images and help diminish possible interference since there is less need of interpretation from the viewer. And of course, are better than the old procedures depicted in Vermeer’s “anatomy lesson” where physicians opened bodies to understand what was beneath the skin. But most importantly, the data generated can contribute to development of more personalized products and medical solutions.

Combining the design way of thinking with the designers’ ability to come up with new products and solutions, designers can start to create tools and products to facilitate communication in interdisciplinary health care meetings.

VUmc Consultations. Image retrieved from TU Delft

The medical field is traditional, consisting of many different specialists, each with their own expertise. Nice and tidy, each his own box. But unfortunately, diseases do not really work that way.

As we are increasingly recognising that diseases tie into different parts of the body, it becomes more important for medical professionals to work together and to look at the patient as a whole, instead of separate parts. No person can ever become experts in all the fields, but we can try to bridge the gap between different expertises. This is where design can play a crucial role.

At the core, design is about understanding a problem from as many different perspectives as possible. Designers try to understand the viewpoints of all the stakeholders, without replacing them by becoming experts themselves. In this way designers try to get an understanding of the problem and the solution, a process known as ‘framing.’ As such designers are really good at facilitating communication; picking up on the essentials and translating it to a language everybody can understand.

Combining this design way of thinking with the designers’ ability to come up with new products and solutions, designers can start to create tools and products to facilitate communication in interdisciplinary health care meetings. Not only can this increased understanding improve the experience of the patient and increase the chances of finding a successful cure for the disease, it can also revolutionize the medical field. By breaking barriers design has the potential to shift the medical field into the 21st century, combining fields that could lead to new insights and a better understanding of the functioning of the human body.

Fortunately, design is getting more and more attention in the medical field. A recent example of design for communication in the medical field is the graduation project of Jesse Beem. He has gotten the opportunity to design for improved communication during multidisciplinary team meetings at the VUmc. He designed an environment to improve discussion among specialists and a tool that brings communication differences into line with visualisation. His design enabled specialists to discuss more efficiently about the patients before deciding on a patient’s diagnosis and treatment. Jesse showed the VUmc how design can facilitate communication and he is currently applying his design to all the meeting rooms in the hospital as the first employed designer at the VUmc.

As said, the design Jesse developed for his graduation, was a tool to make medical professionals communicate better. Compared to a conventional conference/discussion room, his new design was focussed on a centralised conversation. As shown in Figure 1, his new design is similar to the setup of an orchestra. As Jesse said: “..because a consultation between different expertises should sound like a piece of well coordinated music.” To facilitate this, he did not only design the round conference room. He also developed an application that syncs across devices with pictures of the patient (for example a CT-scan) and all medical experts can indicate their thoughts on the patient’s medical situation.
For all viewers in a further row, big screens and a sound installation are installed in the front of the room so that everybody knows who is talking about what. In the end what is most important, is that all professions have discussed effectively and efficiently, making the diagnosed situation and treatment more accurate and less prone to failure.

Although it is good to see the increasing role of design in some parts of the medical field, it is still too little to break the barriers and bring medical care into a new era.

Especially in this field, where a small change could have a huge impact, it is important to make a difference with design. We as designers should push that change.

Human factors Engineering (HFE) use behavioural scientific methods to identify possible design flaws of human device interaction, due to the (sometimes) unpredictability of the human behaviour. It is difficult to rely on logic or intuition alone, with the design of man/machine interactions and human factors provides the means of research and analysis to discover valuable solutions.

Hand proportions. Image retrieved from Joshua Nava Arts