How Are You Doing… Really? A Review of Whole Person Health Assessments.

UNLABELLED

Policy Points A redirection of measurement in health care from a narrow focus on diseases and care processes towards assessing whole person health, as perceived by the person themself, may provide a galvanizing view of how health care can best meet the needs of people and help patients feel heard, seen, and understood by their care team. This review identifies key tensions to navigate as well as four overarching categories of whole person health for consideration in developing an instrument optimized for clinical practice. The categories (body and mind, relationships, living environment and finances, and engagement in daily life) include nine constituent domains. To maximize value and avoid unintended consequences of implementing a new measure, it is essential to ensure adequate time with the person providing the responses. Use of the instrument should be framed around the goal of better understanding a person's whole health and strengthening their relationship with the care team and not for comparisons across physicians or meeting a target score.

CONTEXT

Frustration with the burden of proliferating measures in health care focused on diseases and care processes has added to the growing desire to measure what matters to people, including understanding how people are doing in terms of their whole health. There is no consensus in the literature on an ideal whole person health instrument for use in practice. To provide a foundation for assessing whole person health and support further instrument development, this review summarizes past work on assessing person-reported whole health, articulates conceptual domains encompassing whole health, and identifies lessons from existing instruments, including considerations for administration.

METHODS

A scoping literature review and instrument review were conducted. Concepts from the literature and instruments were thematically coded using a grounded theory approach.

FINDINGS

We identified four overarching categories of whole person health, consisting of nine domains: body and mind (physical well-being, mental/emotional well-being, meaning and purpose [spiritual well-being], sexual well-being), relationships (social well-being), living environment and finances (financial well-being, environmental well-being), and engagement in daily life (autonomy and functioning, activities). A tenth domain of global well-being was used for instruments that assessed well-being as a whole. In total, 281 instruments were examined; most were specific to a single domain or subdomain. Fifty instruments assessed at least three domains; only five assessed all domains identified. Two key tensions must be navigated in the development of a whole person health instrument: comprehensiveness versus brevity, and standardization versus flexibility.

CONCLUSIONS

The array of whole person health domains identified in this review and lack of consensus on how best to measure health present an opportunity to develop a new instrument to support a shift to whole health care. In addition to better tools for assessment, a shift to whole health care will require broader system transformation in payment, care delivery, and the ecology of measurement.