title: Health Values and Treatment Goals of Older, Multimorbid Adults Facing Life-Threatening Illness.
abstract: OBJECTIVE
  To identify a taxonomy of health-related values that frame goals of care of older, multimorbid adults who recently faced cancer diagnosis and treatment.
  
  
  METHODS
  Qualitative analysis of data from a longitudinal cohort study of multimorbid cancer survivors.
  
  
  METHODS
  Cancer registries from regional Department of Veterans Affairs networks in New England and southeast Texas.
  
  
  METHODS
  Multimorbid adults who completed interviews 12 months after diagnosis of head and neck, colorectal, gastric, or esophageal cancer and after cancer treatment (N = 146).
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.|Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas.|Veterans Affairs Quality Scholars Program Coordinating Center, Houston, Texas.
authors.forename: Aanand D
authors.initials: AD
authors.lastname: Naik
authors.affiliation: 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.|Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas.
authors.forename: Lindsey A
authors.initials: LA
authors.lastname: Martin
authors.affiliation: Veterans Affairs Boston Healthcare System, Boston, Massachusetts.|Harvard Medical School, Boston, Massachusetts.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Moye
authors.affiliation: Veterans Affairs Boston Healthcare System, Boston, Massachusetts.|Harvard Medical School, Boston, Massachusetts.
authors.forename: Michele J
authors.initials: MJ
authors.lastname: Karel
mesh_terms: D032722:Advance Care Planning; D000368:Aged; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000628:therapy*; D013727:Terminal Care / Q000592:standards
keywords: advanced care planning; decision-making; multiple morbidities; qualitative