Life Goals and Health Decisions: What Will People Live (or Die) For?

Abstract

Objective. Quality of life may represent not just quality of health but also the degree to which an individual achieves personally meaningful extrinsic goals unrelated to life duration that are not incorporated in the standard quality-adjusted life year model. The objectives of this study are to develop a typology of life goals and explore whether goal type is related to willingness to consider trading life years or health for goals. Design. Surveys of 50 Chicago-area residents and 101 inpatients. Outcomes. Participants provided up to 5 goals. For each, they reported 1) how long the goal might take to achieve, 2) whether they would prefer a shorter lifetime with certain goal achievement to their full lifetime without goal achievement, and 3) whether they would prefer lower quality of health with certain goal achievement to their full health without goal achievement. Results. Participant goals were classified by 2 investigators into 7 broad categories: family, wealth, job, education, health/fitness, travel, and personal fulfillment. Respondents in both samples were more likely to be willing to trade life years (community odds ratio [OR] = 7.39, P=0.0004; patient OR=1.82, P=0.008) or health (community OR= 5.11, P = 0.0042; patient OR = 1.83, P = 0.0498) to achieve family goals than other types of goals. Conclusions. The authors derive a manageable typology of goals that may affect medical decisions and demonstrate interrater reliability. Because willingness to trade life years varies by type of goal, typical time-tradeoff assessments may be systematically influenced by respondents' goals.