Historically, mammography screening has been available to women in diagnostic imaging (radiology) centers and, occasionally, in the offices of large OB-GYN practices. In recent years, however, more comprehensive breast care services have been provided in specialized facilities that offer women more psychosocial support and a full range of services, should they be diagnosed as symptomatic. Even when mammography is part of a diagnostic imaging suite, the goal is usually to separate it from the other imaging modalities, creating a separate entrance and identity (Figures 5-4 and 5-5).
Depending on the anticipated volume of procedures and the potential as a feeder to oncology services, the breast center may be totally independent of diagnostic imaging, having its own ultrasound, mammography, and stereotactic rooms, as well as film filing and reading areas. The proliferation of well-designed, high-profile breast centers in recent years is a reflection of the increased awareness of the benefits of early detection as well as a response to reaching out to women who make most of the healthcare decisions for their families.
The scale and range of breast care centers is demonstrated by the small facility in Figure 4-18 and the somewhat larger one in Figure 4-17, both associated with a community hospital but located in an MOB; Figure 6-6, associated with a large primary-care clinic; Figure 4-19, also under a hospital's license but located in a medical office building with direct access to an ambulatory surgical center; and the largest of these facilities (Figure 4-38) is part of a cancer center, which includes chemotherapy infusion, also associated with a large community hospital, but located in a campus MOB. Interior photos of all of these facilities are included in the book and will be cross-referenced later in this [Image not available in this electronic edition.] discussion. Some have been placed in the Oncology section, others here in the Breast Centers section, and a few appear in Chapters 6 and 13. All of these facilities have outstanding design features in addition to being highly functional in terms of space planning and critical adjacencies.
The possibility of breast cancer strikes such a chord of fear and terror in many women that the anticipation of having a mammogram is filled with dread. This, despite the fact that more women die of heart disease every year than breast cancer. Understanding this context of fear of the unknown, and perhaps the subconscious fear of the possibility of losing a breast if a lesion or tumor is discovered, causes some women to arrive at the facility in an anxious state of mind. Therefore, a design that is calming and soothing will be appreciated. Research shows that connecting people to nature with a view of a Figure 4-17. Space plan, 3495 square feet. Memorial Breast Care Center at Anaheim Memorial Hospital, Anaheim, garden, or a water element like a large fountain, and nat- CA. (Architecture and interior design:Taylor & Associates Architects, Newport Beach, CA.) ural light has immediate physiological benefits in terms of reducing stress. Even a simulated view of nature as in
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Figure 4-18. Space plan, 8436 square feet. Hoag Hospital Breast Care and Imaging Center. (Architecture and interior design: Taylor & Associates Architects, Newport Beach, CA.)
Color Plates 9, 25, and 28, Figures 4-20, 5-70, and 7-15, respectively, is effective. Providing options and choice also reduces stress. Patients who visit the Scripps Breast Care Center (Figures 4-19 and 4-21 and Color Plates 10, 11, Figures 4-22, 4-23, and 4-24) have a choice of five options to fill their time while waiting for the procedure. After gowning, they may sip tea from a china tea service and read magazines; watch a video on breast self-exam; visit the resource library to select a book or video (using wireless headphones) or go on line to research women's health topics; tour the corridors to see the many works of art and contemporary crafts; or visit the positive appearance center to select a gift. Pleasant diversions, according to research, also reduce stress. These include aquariums (Figure 4-50), fountains, soothing music, interactive works of art, or anything that distracts one from worry and fear.
One of the advantages of screening at a breast center, as opposed to having a mammogram at a diagnostic imaging facility, is the psychosocial support that is often available to women who prove to be symptomatic. In the typical scenario, a woman who learns she has a suspicious growth has to wait an agonizing week or two to book an appointment with a primary-care physician who will likely refer the patient for further diagnostic studies. That interval of time can be torturous, whereas, in a breast center, psychosocial support is immediately available through counselors and nurses. Further diagnostic tests can be conducted at the same site with care coordinated by a concerned and familiar team of individuals. A connection to the breast center can be maintained even after surgery and other types of therapy, by virtue of counseling and educational programs as well as support groups.
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