Medline ® Abstract for Reference 1
of 'Discussing goals of care'
Health Values and Treatment Goals of Older, Multimorbid Adults Facing Life-Threatening Illness.
Naik AD, Martin LA, Moye J, Karel MJ
J Am Geriatr Soc. 2016 Mar;64(3):625-31.
OBJECTIVES: To identify a taxonomy of health-related values that frame goals of care of older, multimorbid adults who recently faced cancer diagnosis and treatment.
DESIGN: Qualitative analysis of data from a longitudinal cohort study of multimorbid cancer survivors.
SETTING: Cancer registries from regional Department of Veterans Affairs networks in New England and southeast Texas.
PARTICIPANTS: Multimorbid adults who completed interviews 12 months after diagnosis of head and neck, colorectal, gastric, or esophageal cancer and after cancer treatment (N = 146).
MEASUREMENTS: An interdisciplinary team conducted thematic analyses of participants' intuitive responses to two questions: Now that you have had cancer and may face ongoing decisions about medical care in the future, what would you want your family, friends, and doctors to know about you, in terms of what is most important to you in your life? If your cancer were to recur, is there anything you'd want to be sure your loved ones knew about you and your goals of care?
RESULTS: Analysis revealed five distinct health-related values that guide how multimorbid cancer survivors conceptualize specific health care goals and medical decisions: self-sufficiency, life enjoyment, connectedness and legacy, balancing quality and length of life, and engagement in care. Participants typically endorsed more than one value as important.
CONCLUSION: Older multimorbid adults who recently faced life-threatening cancer endorsed a multidimensional taxonomy of health-related values. These health-related values guide how they frame their goals for care and treatment preferences. Eliciting individuals' sense of their values during clinical encounters may improve their experiences with health care and more effectively align treatments with goals of care.
Center of Innovations in Quality, Effectiveness, and Safety, Houston Veterans Affairs Health Services Research and Development, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.