Journal of General Internal Medicine

, Volume 32, Issue 12, pp 1278–1284 | Cite as

Understanding What Is Most Important to Individuals with Multiple Chronic Conditions: A Qualitative Study of Patients’ Perspectives

  • Catherine Y. Lim
  • Andrew B. L. Berry
  • Tad Hirsch
  • Andrea L. Hartzler
  • Edward H. Wagner
  • Evette J. Ludman
  • James D. Ralston



To improve care for individuals living with multiple chronic conditions, patients and providers must align care planning with what is most important to patients in their daily lives. We have a limited understanding of how to effectively encourage communication about patients’ personal values during clinical care.


To identify what patients with multiple chronic conditions describe as most important to their well-being and health.


We interviewed individuals with multiple chronic conditions in their homes and analyzed results qualitatively, guided by grounded theory.


A total of 31 patients (mean age 68.7 years) participated in the study, 19 of which included the participation of family members. Participants were from Kaiser Permanente Washington, an integrated health care system in Washington state.


Qualitative analysis of home visits, which consisted of semi-structured interviews aided by photo elicitation.

Key Results

Analysis revealed six domains of what patients described as most important for their well-being and health: principles, relationships, emotions, activities, abilities, and possessions. Personal values were interrelated and rarely expressed as individual values in isolation.


The domains describe the range and types of personal values multimorbid older adults deem important to well-being and health. Understanding patients’ personal values across these domains may be useful for providers when developing, sharing, and following up on care plans.


chronic disease comorbidity qualitative research communication values 



We would like to acknowledge Linda Kiel, Luesa Jordan, Zoe Bermet, and Deryn Haug for their valuable contributions to this project. This work was supported by the Agency for Healthcare Research and Quality grant R01 HS022364.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.


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Copyright information

© Society of General Internal Medicine 2017

Authors and Affiliations

  • Catherine Y. Lim
    • 1
  • Andrew B. L. Berry
    • 2
  • Tad Hirsch
    • 2
  • Andrea L. Hartzler
    • 1
  • Edward H. Wagner
    • 1
  • Evette J. Ludman
    • 1
    • 2
  • James D. Ralston
    • 1
    • 2
  1. 1.Kaiser Permanente Washington Health Research InstituteSeattleUSA
  2. 2.University of WashingtonSeattleUSA

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