Evaluating the Benefits of Hospital Room Artwork for Patients Receiving Cancer Treatment: A Randomized Controlled Trial
We examined whether placing a painting in the line of vision of a hospitalized patient improves patient outcomes and satisfaction and whether having patients choose their paintings offers greater benefit. From 2014 to 2016, we enrolled 186 inpatients with cancer diagnoses from Pennsylvania State University Cancer Institute and randomly assigned them to 3 groups: those who chose paintings displayed in rooms, those whose paintings were randomly selected, and those with no paintings. We assessed anxiety, mood, depression, quality of life, perceptions of hospital environment, sense of control and/or influence, self-reported pain, and length of stay and compared patients with paintings versus those without paintings, as well as those with an artwork choice versus those with no choice. There were no differences in psychological and/or clinical outcomes across the groups, but patients in the 2 groups with paintings reported significantly improved perceptions of the hospital environment. Integrating artwork into inpatient rooms may represent one means of improving perceptions of the institution.
© 2018 Society of Hospital Medicine
With hospital reimbursement increasingly being linked to patient satisfaction,1 about half of US hospitals have embraced arts programs as a means of humanizing clinical environments and improving the patient experience.2,3 There is emerging evidence that integrating such programs into clinical settings is associated with less pain, stress, and anxiety4-10 as well as improved mood,11 greater levels of interaction,12 and feeling less institutionalized.13 However, it has been observed that existing studies have been undertaken with variable methodological rigor,14 and few randomized controlled trials (RCTs) have linked specific design features or interventions directly to healthcare outcomes. We designed a RCT to test the hypotheses that (1) placing a painting by a local artist in the line of vision of hospitalized patients would improve psychological and clinical outcomes and patient satisfaction and (2) letting patients choose their own painting would offer even greater benefit in these areas.
METHODS
Outcomes and Measures
The primary outcomes were psychological and included the following: anxiety, mood, depression, and sense of control and/or influence. These were measured using the validated State-Trait Anxiety Inventory (STAI)15 an emotional thermometer instrument (ETI)16, and a self-designed instrument measuring one’s sense of control and influence over the environment. Secondary outcomes were clinical, encompassing pain, quality of life (QOL), length of stay (LOS), and related to perceptions of the hospital environment. These were assessed using data extracted from the electronic medical record (EMR) as well as the Room Assessment (RA) survey, a validated instrument used in prior clinical studies to assess inpatient settings.17 The RA survey uses the Semantic Differential scale, a rating scale designed to measure emotional associations by using paired attributes.18 In our scale, we listed 17 paired and polar opposite attributes, with one descriptor reflecting a more positive impression than the other. Anxiety, emotional state, and control and/or influence were assessed at baseline and prior to discharge; emotional state was assessed every 1 to 2 days; and perceptions of the room and overall patient experience were measured once, prior to discharge, using the RA survey.
Data Analysis
A sample of 180 participants were chosen, with a 2:1 ratio of art group to no-art control group to provide at least 80% power to detect a difference in anxiety score of 4 units, for the comparisons of interest among the groups. The calculations assumed a 2-sided test with α = 0.05.
