BACKGROUND Patients with multimorbidity often receive diverse treatments; they are subjected to polypharmacy and to a high treatment burden. Hence it is advocated that doctors set individual health and treatment priorities with their patients. In order to apply such a concept, doctors will need a good understanding of what causes patients to prioritise some of their problems over others. This qualitative study explores what underlying reasons patients have when they appraise their health problems as more or less important. METHODS We undertook semi-structured interviews with a purposive sample of 34 patients (aged 70 years and over) in German general practices. Initially, patients received a comprehensive geriatric assessment, on the basis of which they rated the importance of their uncovered health problems. Subsequently, they were interviewed as to why they considered some of their problems important and others not. Transcripts were analysed using qualitative content analysis. RESULTS Patients considered their health problems important, if they were severe, constant, uncontrolled, risky or if they restricted daily activities, autonomy and social inclusion. Important problems often correlated with negative feelings. Patients considered problems unimportant, if they were related to a bearable degree of suffering, less restrictions in activities, or psychological adjustment to diseases. Altogether different reasons occurred on the subject of preventive health issues. CONCLUSIONS Patients assess health problems as important if they interfere with what they want from life (life values and goals). Psychological adjustment, by contrast, facilitates a downgrading of the importance. Asking patients with multimorbidity, which health problems are important, may guide physicians to treatment priorities and health problems in need of empowerment.

中文翻译：

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老年患者如何优先考虑其多重健康问题：定性研究。

背景多种疾病的患者经常接受不同的治疗。他们要接受多药治疗并承受很高的治疗负担。因此，提倡医生为患者设定个人的健康和治疗重点。为了应用这样的概念，医生将需要对导致患者将某些问题优先于其他问题的原因有一个很好的了解。这项定性研究探讨了当患者对健康问题进行或多或少的重要评估时，其潜在的根本原因。方法我们采用34例70岁以上的德国普通患者的目标样本进行了半结构化访谈。最初，患者接受了全面的老年医学评估，在此基础上，他们对未发现的健康问题的重要性进行了评估。随后，他们接受了关于为什么他们认为某些问题很重要而其他问题却不那么重要的采访。使用定性内容分析法分析成绩单。结果如果患者严重，持续，不受控制，有风险或限制日常活动，自主权和社会包容性，则认为患者的健康问题很重要。重要的问题通常与负面的情绪有关。如果与可承受的痛苦程度，较少的活动限制或疾病的心理适应有关，则患者认为问题不重要。在预防性健康问题上发生了完全不同的原因。结论如果患者干扰自己的生活需求（生命价值和目标），则他们认为健康问题非常重要。相比之下，心理调整 有助于降低重要性。询问患有多种疾病的患者，哪些健康问题很重要，可以指导医生解决需要优先权治疗的优先事项和健康问题。