Mapping Multisensory Journeys in Pediatric Oncology Care: Toward Emotionally Intelligent Healthcare Environments

2.1 Data collection

Data collection was conducted through questionnaires and user observations. The questionnaires provided structured insights into emotional responses (Creswell & Miller, 2000), while user observations documented behavioral cues and emotional reactions in real-time hospital journeys and environments (Ranne, 2019). The collected data were analyzed using thematic analysis, identifying key factors affecting the pediatric patient experience, such as environmental attractiveness, coherence of sensory elements, and emotional responses. A new systematic method for mapping multisensory information in hospital settings was developed, providing a tool for designers and healthcare providers to enhance the patient journey. Ethical considerations included obtaining informed consent from both children and their guardians, anonymizing data, and demonstrating sensitivity toward participants’ emotional states.

2.2 Participant

The main participants of the study were pediatric cancer patients undergoing palliative care at the One Day Care Therapy facility at X Hospital in Surabaya. The study focused on children aged 5–12 years, who were considered capable of expressing their sensory and emotional experiences both verbally and nonverbally. Adolescent and young adult patients were excluded due to significant differences in cognitive developmental stages and spatial perception. Only pediatric cancer patients without eye disorders were included. All participants were in stable health conditions, receiving care in the One Day Care Therapy Room, and had been recommended by a physician. All participants were enrolled following a structured three-stage informed consent procedure. First, the hospital team conducted an initial review to identify eligible pediatric cancer patients whose medical and psychological conditions were stable and appropriate for the study, and granted approval for their inclusion. Second, the observation procedures were explained in clear, age-appropriate language to both the children and their parents/guardians, after which verbal confirmation was obtained from the parents/guardians regarding their willingness to allow participation. Finally, the guardians signed a written informed consent form as official confirmation of their permission for their child’s involvement in the study, while verbal assent was obtained from the children. Thus, all procedures were conducted in compliance with ethical standards for research involving human subjects, and all participant identities and data were treated with strict confidentiality in accordance with applicable regulations.

2.3 Ethical approval

This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Ethical approval for all study protocols was obtained from the Health Research Ethics Committee of RSUD Dr. Soetomo Surabaya, Indonesia, under approval number 0666/KEPK/V/2023. RSUD Dr. Soetomo served as the institution where data collection was carried out among patients receiving treatment, and the research adhered to the hospital’s institutional regulations as well as international ethical standards. The observation procedures were explained in clear, age-appropriate language to both the children and their parents/guardians, after which verbal confirmation was obtained from the parents/guardians regarding their willingness to allow participation. The guardians signed a written informed consent form as official confirmation of their permission for their child’s involvement in the study, while verbal assent was obtained from the children. All data were handled with strict confidentiality and used solely for research purposes.

3.1 Contextual understanding

The contextual mapping revealed that pediatric cancer patients experienced a wide range of emotional and sensory responses across different stages of their treatment journey. By following the patients from their point of departure (home or shelter), through transportation, hospital entry, and ultimately back home, the research uncovered key spatial and temporal touchpoints that significantly shaped their psychological and sensory experiences. Based on interviews with psychologists involving 24 participants, it was found that most participants did not experience significant distress. The patients’ current stress levels remained within a normal and manageable range. Although a few participants exhibited higher distress scores compared to others, these levels were still considered tolerable. Overall, all participants demonstrated adequate social support from parents and family, which helped foster enthusiasm in their daily activities.

However, in relation to their cancer diagnosis, only eight participants showed distress with a moderately elevated risk, and only one participant was found to have a moderately high stress level. The remaining participants generally did not display significant emotional distress. On average, their emotional expressions manifested as frustration or tantrums in response to unfulfilled desires, particularly during the early stages of chemotherapy when patients were required to undergo intensive treatment procedures. Emotional volatility at this stage was commonly triggered by the demanding nature of the treatments. Parental, familial, and peer support also played an essential role in regulating emotional responses. Regarding the patient experience during chemotherapy, participants generally paid more attention to details during the journey to the hospital and reported enjoying that part of the experience. In contrast, feelings of anxiety were more commonly expressed upon arrival at the hospital. In conclusion, the majority of pediatric cancer patients involved in this study were categorized as having low stress levels. Variations in stress appeared to be correlated with both the stage of treatment and the severity of illness experienced by the patients.

3.2 User journey definition

The second step in this research is defining the user journey, which involves identifying and interpreting the journey of pediatric cancer patients as they navigate to, through, and from the hospital environment. This step aims to go beyond surface-level observations by exploring how patients experience each stage of their journey emotionally and sensorially. The patient journey was segmented into three phases: before hospital arrival, during spatial navigation within hospital premises, and after treatment or consultation (Ranne, 2019). Each phase outlined the patient’s actions, sensory perceptions, and dominant sensory modalities based on empirical data triangulated with thematic analysis and relevant literature (Gibson, 1996; Whitehead et al., 2016).

3.3 Data sensory collection

The third step in this research involves sensory data collection, carried out through a combination of direct, non-intrusive observation and structured environmental scanning along the pediatric patient’s entire treatment journey. The researcher follows the same spatial path experienced by the children from their home or shelter, during transport, entering the hospital, navigating waiting areas and corridors, undergoing treatment, and returning, while documenting multisensory stimuli in each segment. Observations focus on what patients visually capture and respond to, including lighting, color schemes, signage, spatial openness, and social interactions. In addition to visual elements, attention is given to auditory cues (e.g., ambient sounds, voices, machinery), tactile sensations (e.g., textures, temperature), olfactory inputs (e.g., antiseptics, food, outside air), and the general emotional tone of each space.

Data analysis follows a thematic and spatial mapping approach. First, responses are transcribed and coded to identify recurring emotional and sensory themes such as calmness, anxiety, curiosity, or discomfort, linked to specific sensory inputs (e.g., loud noise, dim light, cold surfaces). Using tools from qualitative content analysis, these codes are grouped into categories (e.g., sensory coherence, overstimulation, emotional readiness). Simultaneously, data are plotted visually using multisensory journey maps to spatially trace how sensory experiences shift along the treatment path. By overlaying environmental features with emotional reactions, the analysis reveals which areas and stimuli contribute positively or negatively to the patient’s well-being. This integrated method, combining thematic analysis with visual-spatial mapping, enables the researcher to interpret how architecture and sensory conditions shape children’s emotional states, supporting evidence-based design recommendations.

3.4 Theme categorization

Understanding how pediatric patients emotionally perceive the healthcare environment requires more than observing spatial flow or sensory stimuli in isolation; it calls for a robust framework that interprets emotional reactions to multisensory experiences. In this research, Mehrabian and Russell’s (1974) PAD model (Pleasure, Arousal, Dominance) is used as a foundational tool for emotional theme categorization. This model provides a validated psychological framework to map environmental perceptions along three core emotional dimensions: pleasure (how enjoyable or satisfying a space feels), arousal (the degree of emotional activation or stimulation), and dominance (the sense of control or agency one feels in the space).

In practical application, the PAD model enables researchers to classify pediatric patients’ reactions during various phases of their treatment journey—from their homes or shelters, through hospital entrances, corridors, and treatment rooms, to the return trip. For example, children who described their journey as “interesting,” “safe,” or “nice” may be interpreted as experiencing high pleasure and low arousal, placing their emotional response in the serene quadrant of the PAD matrix. Conversely, when children described their journey as “noisy,” “confusing,” or “scary,” these responses may fall under high arousal and low pleasure, indicating a stressful or overwhelming experience. The detailed mapping of patient statements into the PAD model quadrants is presented in Table 1, which illustrates how verbal expressions were systematically categorized.

In PAD theory, there are quadrants of affective response based on human reactions to the environment. Patients’ perceptions of the environment can be positioned within these quadrants. The researcher attempts to map the words expressed by the patients into the appropriate PAD quadrant, while also cross-referencing their facial expressions and body language with the verbal statements they made. Patients’ feelings can be interpreted through their choice of words. To assess patients’ emotional states, this study considers their verbal expressions, as the specific words they choose often reflect their inner feelings and psychological responses (Mehrabian, 1996).

Based on the identified multisensory journey, pediatric cancer patients with low stress levels were found to fall within the Pleasure and Arousal quadrants of the PAD model, as shown in Figure 2. According to the data, the larger the circle, the greater the number of patients who expressed and exhibited the corresponding emotional response. In contrast, patients with high stress levels were found to fall within the Displeasure and Non-Arousal quadrants, as illustrated in Figure 3.

Figure 2. PAD quadrants of patients during chemotherapy for those with low stress levels.

Figure 3. PAD quadrants of patients during chemotherapy for those with high stress levels.

Based on the analysis of the multisensory journey and its relation to the PAD model, it can be concluded that sensory environments significantly influence the emotional responses of pediatric cancer patients. Patients with low stress levels tended to associate their experiences with environments that induced feelings of pleasure and arousal—characterized by calmness, curiosity, and emotional engagement—indicating a more positive and responsive interaction with their surroundings. This was reflected in the higher frequency of positive words and corresponding facial expressions. Conversely, patients experiencing high stress were predominantly mapped within the Displeasure and Non-Arousal quadrants, revealing emotional states marked by withdrawal, discomfort, and a lack of engagement. These contrasting patterns suggest that the design of sensory-rich, emotionally supportive environments plays a critical role in shaping psychological outcomes for pediatric patients during treatment.

3.5 Mapping sensory flow and cross-modal interactions

This study categorizes participants into two distinct stress-level groups, low and high, based on observed behavioral and emotional indicators during the chemotherapy process. The categorization emerged from an emic approach, in which the researcher directly accompanied pediatric patients during treatment, allowing for immersive and context-sensitive observations. Of the 24 patients involved, 8 were identified as experiencing high stress and 16 as experiencing low stress. These groupings formed the analytical framework for examining variations in their multisensory experiences throughout the treatment journey.

Qualitative data were coded thematically across five sensory modalities, such as, visual, auditory, haptic, olfactory, and gustatory—along with affective-emotional responses (Ranne, 2019). This framework revealed that children did not experience the hospital as a singular place but rather as a succession of interconnected sensory environments, each with the potential to either soothe or heighten emotional stress (see Figure 4). Consistent with Pallasmaa’s (2024) phenomenological approach to architecture, the child’s body was understood as a site of multisensory interpretation and meaning-making, where emotion arises not in abstraction but through embodied interaction with spatial and sensory cues.

Figure 4. The multisensory user journey map.

Notes: The left column (steps 1-19) describes different phases of the momentary UX, affecting the sensation column presenting the current feeling of the user, and the upper column divides sensations based on Gibson’s perceptual system (1987). The building column explains how the system reacts to the user and the notes column further explains the choices.

For instance, visually, engaging signage, colorful furnishings, and the presence of play materials contributed to distraction and cognitive engagement, providing children with a sense of control over unfamiliar surroundings (Devlin & Arneill, 2003). Auditory experiences, including gentle background music and familiar voices, acted as emotional anchors, helping children navigate transitions between emotionally charged zones such as treatment rooms and waiting areas. Tactile experiences—such as plush seating or soft furnishings—were consistently mentioned or observed as sources of comfort, buffering anxiety related to clinical procedures (Malchiodi, 2008). Even olfactory stimuli, often overlooked in clinical design, played a critical role: the scent of antiseptics was sometimes balanced by the smell of books, familiar food, or ambient fragrances, evoking a sense of normalcy and grounding (Herz et al., 2004).

The qualitative evidence thus suggests that sensory coherence—defined as the predictable, integrative, and emotionally attuned alignment of sensory inputs across different hospital zones—is essential in supporting emotional resilience. Emotional trajectories captured during this study often began with excitement or curiosity, dipped into mild anxiety during clinical interventions, and then returned to states of calm or relief. These dynamic affective patterns affirm the importance of designing hospital journeys as multisensory and emotionally intelligent experiences. This sensory mapping extended beyond clinical environments to include transitional spaces such as car rides to the hospital, waiting areas, corridors, and recovery zones. Drawing from the concept of transitional space in healthcare design (Suddick et al., 2021), these zones serve as psychological and physiological buffers between different phases of the care experience. When designed with sensory responsiveness in mind, they facilitate orientation, mitigate fear, and support emotional continuity. High-tier design strategies must therefore view hospital spaces not as isolated rooms but as parts of a continuous sensory-emotional journey that children must navigate.

Following the descriptive mapping of hospital journeys experienced by children with lower stress levels, this section offers a thematic interpretation of the data. Utilizing a sensory-emotional lens grounded in environmental psychology and healthcare design literature, the analysis was structured around six interrelated sensory domains: emotional/affective, visual, auditory, tactile, olfactory/gustatory, and environmental-spatial. These categories emerged inductively through a reflexive thematic analysis (Braun & Clarke, 2006), shaped by direct observation, participatory fieldwork, and interpretive engagement with multisensory experiences. Each theme reflects how children navigated their hospital environments emotionally and physiologically, revealing how supportive environmental design can mitigate distress and promote emotional resilience.

The multisensory journey mapping of pediatric cancer patients with high stress levels reveals environments marked by sensory fragmentation, emotional dissonance, and a lack of responsive design (see Figure 5). These children navigated hospital visits not through comfort, but through survival strategies, enduring unpredictable, overstimulating, or barren settings that heightened their distress. Emotional states such as fear, disorientation, and helplessness were most intense during pre-treatment transitions and medical interventions and were exacerbated by the absence of emotionally attuned stimuli.

Figure 5. The multisensory user journey map for high level of stress based on Gibson’s perceptual system (1996).

Visual inputs were often described as dim, monotonous, or sterile, lacking child-friendly features such as color, narrative artwork, or spatial landmarks. Auditory environments were dominated by clinical sounds—beeping machines, abrupt staff conversations, and ambient hallway noise—with no counterbalance in the form of soothing music or nature-based soundscapes. This sensory imbalance aligns with findings by Coyne et al. (2016) and Ulrich et al. (2008), who demonstrate that unregulated or monotonous environments in pediatric settings can amplify anxiety and reduce emotional coping capacity. Tactile experiences further contributed to the children’s stress. Cold surfaces, hard chairs, and repeated painful procedures (e.g., IV insertions) offered no comforting haptic counterpoints. Without access to soft or familiar textures, children had limited physical grounding. Similarly, olfactory stimuli—predominantly antiseptic and medicinal—triggered strong aversive reactions, particularly in children undergoing repeated chemotherapy. As Herz et al. (2004) emphasizes, negative olfactory memories can anchor traumatic associations and intensify anticipatory fear.

While some calming features were present, such as soft lighting and ergonomic seating, these elements were static, impersonal, and uniformly applied, failing to respond to children’s evolving emotional needs. This underscores the limitations of one-size-fits-all design in pediatric care. As noted by Malchiodi (2008), pediatric spaces must dynamically adapt to individual emotional rhythms, integrating multisensory cues that offer orientation, distraction, and comfort. Without such interventions, the journey becomes not only physically taxing but emotionally disintegrating. These findings suggest a critical need for trauma-sensitive, multisensory design frameworks in pediatric oncology environments—frameworks that not only accommodate medical function but also actively engage with the child’s sensory world to reduce fear, restore agency, and promote emotional resilience.

3.6 Assessing coherence and emotional friction

In this study, assessing coherence and emotional friction revealed how the alignment or lack thereof between environmental stimuli and patient perception significantly influenced pediatric cancer patients’ emotional responses throughout their healthcare journey. For patients in the low-stress group, a sense of coherence emerged when sensory inputs such as lighting, sound, texture, and spatial rhythm were consistent and predictable, creating feelings of safety, curiosity, and emotional readiness. Conversely, high-stress patients frequently experienced emotional friction, especially in transitional areas, where inconsistent sensory cues, abrupt spatial changes, or overwhelming stimuli disrupted their emotional equilibrium. These frictions manifested as discomfort, anxiety, and psychological resistance, particularly when entering unfamiliar or overstimulating spaces. By mapping these moments across the journey from home to hospital and back, this research underscores that emotional friction often arises not from the clinical procedure itself, but from poorly integrated or disjointed sensory and spatial experiences. Thus, emotional coherence is not only a psychological state but an architectural outcome, reinforcing the necessity for sensory-informed, empathetic design in pediatric healthcare settings. The final thematic domain integrates the physical-spatial structure of the hospital environment. The overall spatial sequence—home, vehicle, entrance, waiting, treatment, recovery, and departure—was characterized by coherent design logic. Transitions between spaces were marked by consistent lighting, flooring, color palettes, and signage, allowing children to predict and adapt to new environments without disorientation. Here is the explanation of the coherence of each sensory modality in relation to the patient’s journey.

The visual environment consistently lacked the narrative, symbolic, and playful elements necessary for pediatric engagement. Dimly lit corridors, monochrome walls, and sparse decoration characterized transitional areas. Children noted the “dark hallway,” “boring walls,” or “no fun things here” when moving between spaces. Even in treatment rooms, the visual landscape was described in utilitarian terms, with minimal color, artistic cues, or spatial zoning to differentiate one stage of care from another. Visual stimuli played a fundamental role in shaping how children interpreted their environments. The presence of vibrant colors, thematic murals, interactive displays, and visibility of play areas transformed otherwise passive or anxiety-inducing spaces into zones of active engagement. These features functioned as more than decorative elements; they redirected attention away from clinical stressors and toward child-friendly narratives. This corresponds with Devlin and Arneill’s (2003) findings that environmental color and design in pediatric settings can modulate anxiety levels by promoting a sense of familiarity and welcome. In particular, the transition areas—waiting rooms, corridors, and entrances—benefited from visually engaging features that served as transitional markers and emotional buffers. The findings also reflect Batchelor et al. (2023), who emphasize the role of environmental art in creating zones of positive distraction, aiding emotional resilience during uncertain or stressful moments.

Sound played a paradoxical role throughout the children’s hospital journey—both omnipresent and emotionally destabilizing. In clinical zones, beeping monitors, echoing footsteps, abrupt medical conversations, and mechanical noises dominated the auditory environment. These sounds were rarely balanced by calming or intentional auditory design, often leaving children overstimulated or unsettled. They frequently described these areas as “noisy,” “too loud,” or filled with “lots of machine sounds,” which often coincided with visible signs of distress or requests for distraction tools. Rezaee Vessal et al. (2024) emphasize that unmanaged hospital soundscapes can act as emotional stressors, particularly for pediatric patients with limited contextual understanding. The absence of modulated auditory inputs such as soft music, nature sounds, or child-friendly tones meant that clinical spaces lacked the sensory relief necessary for emotional regulation. In contrast, auditory experience was not merely passive but central to children’s emotional navigation and spatial orientation.

Interestingly, during the journey to the hospital, sound was often interpreted more positively. Children who traveled by ambulance found enjoyment in the siren, a sound that, while loud, was perceived as meaningful and exciting, functioning as a form of positive distraction. Similarly, children who departed from home or shelters expressed pleasure in listening to music or engaging in conversations with parents during the trip. The journey itself—filled with familiar street views, people, and dynamic soundscapes—provided sensory continuity and a buffer before entering the clinical environment. These auditory elements helped reduce perceptual gaps across spatial transitions and reinforced a sense of emotional coherence and orientation.

Tactile experiences played a powerful yet often overlooked role in how children coped with medical environments. Materials such as soft seating, fuzzy blankets, familiar toys, and rounded furnishings offered a sense of normalcy and embodied comfort. These haptic cues helped mitigate the intrusiveness of cold instruments, sterile furniture, and the tactile invasiveness of medical procedures. Malchiodi (2008) emphasizes that tactile engagement—especially with comforting or familiar textures—can promote emotional self-regulation in pediatric patients, particularly during moments of uncertainty, pain, or sensory overload. In this study, children were often observed seeking tactile constancy. For instance, the presence of a personal item, such as a pillow or stuffed animal, served as a mobile source of sensory stability across different spaces. Children with both low and high levels of stress expressed increased haptic sensitivity throughout the journey. They often described sensations of cold—weather from the air-conditioned transport, metal furniture, or vinyl seats—as unpleasant and discomforting. Interestingly, during the chemotherapy process, several children reported feeling warm or sweaty shortly after the medication was administered, a physiological reaction to the treatment that further highlights the importance of recognizing real-time changes in haptic perception.

When touch is unmediated by comfort or control, it becomes a source of heightened vulnerability. Children frequently referenced pain or discomfort, saying “the needle hurts,” “cold chair,” or “I don’t want to be touched,” revealing the predominance of aversive tactile encounters in certain zones. The treatment rooms, in particular, lacked haptic counterbalances such as plush textures, weighted comfort tools, or soft fabrics that might have helped ground children emotionally. As Malchiodi (2008) asserts, the haptic domain carries therapeutic potential when intentionally integrated into trauma-sensitive care. Its absence deprived children of one of the most intuitive and immediate sensory pathways to emotional regulation—especially critical during medical interventions or emotional distress.

Olfactory and gustatory inputs, though less consciously perceived than visual or auditory stimuli, played a subtle yet emotionally resonant role throughout the pediatric patients’ journeys. The sensory environment was largely dominated by antiseptic, medicinal, and chemical scents—aromas that children frequently associated with discomfort or fear. Comments such as “it smells like medicine,” “I don’t like the hospital smell,” or “gross” were common, especially in treatment zones and corridors. Herz et al. (2004) emphasizes that scent is deeply linked to emotional memory and can act as a powerful, often subconscious trigger of affective states. In this context, the predominance of negative olfactory cues often served as a sensory “primer,” activating emotional tension even before clinical procedures began. Interestingly, children did not always spontaneously recognize or report olfactory input during interviews. The researcher often needed to prompt or recall their awareness of smell. Once prompted, many children showed clear preferences, particularly for pleasant scents such as vanilla or food brought from home. This aligns with Herz et al. (2004) findings on the emotionally anchoring effect of familiar scents. In more public or transitional areas, such as waiting rooms or near hospital cafés, the occasional presence of ambient odors like food, sweet perfumes, or even scented books created a subtle olfactory layering effect. These non-clinical scents allowed children to emotionally tether themselves to positive associations, offering brief moments of sensory relief amid the dominant hospital aroma.

Mapping the multisensory journeys of pediatric cancer patients under high stress reveals a clear pattern of emotional disorientation and sensory overload. Unlike children in low-stress groups who benefited from consistent and emotionally supportive spatial environments, high-stress patients encountered unpredictable and often aversive sensory inputs. These inconsistencies were not isolated events but rather cumulative disruptions, triggering emotional, behavioral, and physiological distress across multiple phases of care. In the early transition stages of the hospital experience (Steps 1–5), children expressed fear, anxiety, and avoidance. Verbal statements such as “I’m scared to go to the hospital” were reinforced by nonverbal cues—averted gaze, physical withdrawal, or tightly gripping caregivers—all signaling a reduced sense of agency and heightened emotional arousal. As treatment progressed (Steps 6–14), these reactions often escalated into ambivalence and emotional detachment. Many children showed passive compliance, distraction-seeking, or withdrawal, suggesting a reduced capacity for self-regulation in the face of ongoing environmental stressors. These observations align with Coyne et al. (2016) findings that children in clinical settings frequently experience a profound loss of control, particularly during unfamiliar or painful procedures. Emotional insecurity is further intensified by a child’s inability to anticipate what will happen next—a critical component of psychological safety in pediatric care (Ulrich et al., 2008).

Although many hospital spaces include conventional child-friendly features such as ergonomic furniture, soft lighting, and muted color palettes, these elements were often standardized and failed to respond to the children’s shifting emotional states. Descriptions like “same everywhere,” “just another room,” or “calming but boring” illustrate that these environments lacked personal relevance and failed to offer meaningful orientation or relief. The repetitive sensory scripts across different areas created a sense of monotony, deepening emotional disconnection instead of reducing distress. This design uniformity limited the environment’s ability to act as an emotional anchor. In contrast to settings that adapt dynamically to sensory and psychological needs, these standardized environments reinforced feelings of being lost or emotionally unsupported, especially among children under high stress. A synthesis of findings across all six sensory domains—visual, auditory, tactile, olfactory, gustatory, and spatial rhythm—shows that positive, low-stress patient journeys are not accidental. Instead, they are actively shaped through coherent, predictable, and emotionally attuned sensory design. When sensory cues such as light, sound, touch, and smell are harmonized across spatial transitions, children feel more oriented, emotionally stable, and psychologically prepared, even when facing unfamiliar or invasive procedures. In conclusion, these insights support a growing body of evidence emphasizing the importance of sensory integration in pediatric healthcare design (Malchiodi, 2008; Spence & Gallace, 2011). Aligning sensory coherence with emotional regulation offers a critical framework for embedding sensory intelligence into pediatric environments, making them not only clinically effective but also emotionally resilient.

3.7 Reflective interpretation and design implications

In the final phase of this research, the multisensory and emotional data collected from pediatric cancer patients were synthesized through reflective interpretation to identify patterns and meanings behind their experiences. This step not only deepens the understanding of how sensory stimuli influence emotional responses but also bridges the gap between empirical findings and practical architectural interventions. The following discussion outlines the key interpretive insights and translates them into actionable design recommendations tailored to pediatric healthcare settings.

This study’s findings indicate that pediatric cancer patients perceive healthcare spaces as emotionally charged, multisensory environments rather than neutral backdrops for treatment. Each stage of the journey—from home, through hospital spaces, to the chemotherapy room—elicits distinct emotional responses shaped by environmental stimuli such as lighting, sound, smell, and spatial transitions. For children in the low-stress group, a consistent and coherent sensory environment fostered emotional regulation, curiosity, and comfort. In contrast, children in the high-stress group often encountered sensory incoherence, abrupt spatial changes, or overstimulating transitions, which led to emotional friction manifested as anxiety, discomfort, or psychological withdrawal. These outcomes support existing research highlighting the importance of multisensory coherence in reducing stress and promoting well-being in clinical environments (Kipps & Erdman, 2025; Rezaee Vessal et al., 2024). This reflective analysis underscores that emotional reactions in pediatric patients often arise not from clinical procedures themselves, but from how environments are perceived and experienced through the senses (Spence & Gallace, 2011).

The implications for architectural design are both practical and urgent. Transitional spaces such as corridors, waiting rooms, and entrances—often overlooked in conventional planning—should be reimagined as therapeutic thresholds that prepare and support children emotionally. Research shows that these areas can significantly affect psychological readiness and overall experience (Batchelor et al., 2023). To that end, spatial design should prioritize sensory consistency, clarity of navigation, and child-scaled features to provide a sense of control and reduce uncertainty. The use of positive distractions, such as interactive visual displays, calming acoustics, and natural light, aligns with Ulrich’s (1991) theory of supportive design and has been shown to mitigate distress in pediatric care. These insights call for a paradigm shift in pediatric healthcare design: from clinically efficient to emotionally intelligent environments.