Vorstellungen guten Lebens von Erwachsenen mit chronischen Herzerkrankungen

Eine empirisch-informierte Reflexion des medizinischen Lebensqualitätsbegriffs am Beispiel eines kardiologischen Anwendungsfeldes

Ideas of the Good Life among Adults with Chronic Heart Disease

An Empirically Informed Analysis of the Medical Concept of Quality of Life in Cardiology

by Lisa Nebel
Cumulative thesis
Date of Examination:2025-12-12
Date of issue:2026-01-06
Advisor:Prof. Dr. Christoph Herrmann-Lingen
Referee:Prof. Dr. Christoph Herrmann-Lingen
Referee:Prof. Dr. Claudia Wiesemann
Persistent Address: http://dx.doi.org/10.53846/goediss-11729

 

 

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Abstract

English

Background: Quality of life is established in medicine as one of three legally defined endpoints and is typically assessed from the patient’s perspective across physical, psychological, and social dimensions. However, this health-related operationalization proves insufficient, particularly in the context of chronic illness. In such cases, physical limitations, psychological burdens, and social challenges become integral parts of everyday life and significantly influence how life is shaped. Individual preferences, the pursuit of goals, and the experience of meaning gain importance – dimensions more closely aligned with broader understandings of quality of life, such as those promoted by the WHO. Objective: This study aims to identify core aspects of a good life in the context of chronic heart disease in order to expand the measurement of health-related quality of life and bridge the gap between conceptual understanding and practical operationalization. Methods: The study combines conceptual and empirical approaches. First, the relationship be-tween quality of life and a good life is analyzed from a theoretical-methodological perspective to identify shortcomings in current measurement practices. This is followed by a systematic meta-synthesis of international qualitative studies on patient-centered concepts to uncover implicit aspects of a good life in the context of chronic heart disease. Due to the limited number of relevant studies in Germany, an additional qualitative study was conducted with affected adults in this country. Both studies use Interpretative Phenomenological Analysis (IPA; Smith et al. 2022). Results: Findings indicate that aspects of a good life correspond to the familiar dimensions (physical, psychological, social) but exhibit a more existential depth. Regaining a fundamental sense of bodily trust – enabling interaction with the world – is central. Interpersonal relation-ships are not only experienced as sources of practical and emotional support but also as sources of meaning that may deepen through illness. A key theme is the need for self-determination – to actively shape one’s life rather than be defined by the illness. This often relates to the desire to restore a sense of normality and align one’s self-image with previous conceptions of self. At the same time, patients report that acceptance is an essential element of a good life: the ability to integrate new qualities into the self and grow through the illness. This can lead to a renewed appreciation for life itself. Temporal aspects also emerge as significant – such as the loss of temporal autonomy and the experience of biographical disruption due to the sudden onset of illness. Conclusions: The results reveal that, in addition to physical, mental, and social well-being and functioning, existential and meaning-related dimensions are equally important for living a good life with chronic heart disease. Future research should more strongly incorporate these perspectives. In practice, this means supporting patients not only with symptom management but holistically – considering their life goals, autonomy, and need for meaning.
Keywords: Chronic Heart Disease; Sudden Cardiac Arrest; Myocardial Infarction; Ischemic Heart Disease; Cardiac Arrhythmia; Quality of Life; The Good Life; Normalcy; Lived Experiences; Meta-Synthesis; Interpretative Phenomenological Analysis; Qualitative Methodology
 
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