Health Values and Treatment Goals of Older, Multimorbid Adults Facing Life-Threatening Illness

ObjectivesTo identify a taxonomy of health-related values that frame goals of care of older, multimorbid adults who recently faced cancer diagnosis and treatment. DesignQualitative analysis of data from a longitudinal cohort study of multimorbid cancer survivors. SettingCancer registries from regional Department of Veterans Affairs networks in New England and southeast Texas. ParticipantsMultimorbid adults who completed interviews 12months after diagnosis of head and neck, colorectal, gastric, or esophageal cancer and after cancer treatment (N=146). MeasurementsAn 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? ResultsAnalysis 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. ConclusionOlder 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.