What components of well-being and health are valued by people with multiple chronic diseases?

The goal of medicine, in broad strokes, is to help people live longer, live better, or both. But what does "live better" really mean? This study identified what patients with multiple chronic diseases think are the most important aspects well-being and health: principles (ideals, virtues, and aspirations), relationships with others, comfort and serenity (freedom from pain and anxiety), enjoyable activities, mental and physical abilities, and possessions. Finding out what is really important to patients with chronic illnesses may help us to better match our interventions to their goals. (LOE = 4)

Lim CY, Berry AB, Hirsch T, et al. Understanding what is most important to individuals with multiple chronic conditions: a qualitative study of patients' perspectives. J Gen Intern Med 32(12):1278-1284.  [PMID:28849368]

Qualitative

Government

Outpatient (any)

"Health is more than absence of disease" explains what health isn't; it doesn't really explain what well-being and health are. To investigate this definition, investigators interviewed 31 older patients (mean age 68.7 years) with multiple chronic conditions using a semistructured interview format as part of a 2-hour home visit. To encourage self-reflection, participants were provided with an instant camera at least 1 week before the interview to take up to 10 photos of anything they considered to be important to their well-being and health. The interviews were transcribed and coded by 2 investigators using a grounded theory approach. The result was 6 core domains of personal values, which often overlapped and sometimes conflicted with one another: (1) principles, or beliefs and standards to live by, which included spirituality or aspirations such as maintaining independence; (2) relationships, consisting of social connections with family, friends, and groups; (3) emotions, such as joy, pride (sense of accomplishment), comfort (absence of pain), and serenity; (4) maintaining activities in their everyday lives; (5) maintaining physical and mental abilities; and (6) possessions (personal possessions, but also medications and other health aids that are in their lives). I wonder whether most patients will have the in-the-moment insight to identify what is most important to them during an office visit; having these categories in mind to prompt patients might help them figure it out so we can better direct their care.