Opportunities and challenges of the oncology infrastructure as a tool for enhancing patient-centered care — developing a physical built environment (p-BE) index for cancer care

Introduction. Cancer care remains fundamentally anchored in physical infrastructures, with oncology infrastructure (OI) serving as the main interface between patients and the healthcare system. Despite increasing recognition of how the built environment (BE) can shape health experiences, its systematic evaluation and integration within OIs remains limited and underutilized. Material and methods. This study employed a mixed-methods framework to develop and validate the physical built environment (p‑BE) index, aimed at evaluating how OI interfaces support or constrain care delivery. The methodology was structured around the identification and analysis of 21 patient-facing components of the BE. Each component was operationalized into measurable indicators and grouped into six composite variables reflecting patient functional capabilities and infrastructure performance. Spatial and perceptual data were collected through service design (SD), user experience (UX), and user interface (UI) methodologies, combined with architectural tools (GIS, BIM) and a structured questionnaire administered to 286 breast cancer patients. Statistical validation was performed using analysis of variance (ANOVA), regression analysis, and principal component analysis (PCA). Results. Among the six interface-based variables constructed from 21 components of the BE, three demonstrated statistically significant associations with patient-reported well-being: navigation and wayfinding (p = 0.00478), accessibility and comfort (p = 0.00296), and physical infrastructure status (p = 0.00288). Mediation analysis revealed that the perceived importance of each component modulated its effect on well-being. Integration of these findings for the creation of the infrastructural DT (IDT) enabled the identification of zones with higher risk for infrastructural underperformance and reduced patient capability. Conclusions. Rather than offering a definitive measure, the p‑BE index should be understood as a first step toward making OI visible as a psychosocial actor in care delivery. This study highlights the opportunities that interdisciplinary frameworks can offer, providing a lens to understand and improve how the BE shapes care delivery — by enabling patient capacities or exposing the underperformance of critical interfaces. The p‑BE index invites further exploration, adaptation, and critique across diverse cancer care settings.