Multidimensional Well-being in Palliative Care: Operationalizing WHO’s Constitutional Vision Across Clinical and Public Health Systems

Tamriko Bulia; Tina Beruchashvili; Ioseb Abesadze; Alexandre Khutsishvili; Mikheil Chelidze; David Makhashvili; Bakho Dvali

doi:10.52340/gs.2026.08.01.17

Authors

Tamriko Bulia School of Health Sciences, The University of Georgia
Tina Beruchashvili School of Health Sciences, The University of Georgia
Ioseb Abesadze Tbilisi State Medical University
Alexandre Khutsishvili Georgian Institute of Public Affairs
Mikheil Chelidze Georgian Institute of Public Affairs
David Makhashvili Clinic Rustavi LLC
Bakho Dvali New Vision University

DOI:

https://doi.org/10.52340/gs.2026.08.01.17

Abstract

Background:
In 1948, the World Health Organization (WHO) defined health as a state of complete physical, mental, and social well-being. Despite this foundational vision, contemporary health systems continue to prioritize biomedical outcomes over multidimensional well-being. The growing global burden of serious health-related suffering, particularly in the context of non-communicable diseases and population ageing, underscores the urgency of operationalizing well-being within palliative care and public health systems.

Objective:
This paper aims to conceptualize and operationalize multidimensional well-being in palliative care by integrating WHO’s constitutional definition with contemporary empirical evidence and health systems frameworks.

Methods:
A narrative, conceptually driven synthesis of global policy documents, randomized clinical trials, health systems research, and well-being measurement literature was conducted. Key sources include WHO policy resolutions, the The Lancet Commission on Palliative Care and Pain Relief, and peer-reviewed empirical studies on early palliative care, dignity-based interventions, caregiver outcomes, and cost-effectiveness.

Results:
Evidence demonstrates that early and integrated palliative care improves quality of life, reduces depressive symptoms, enhances existential well-being, decreases avoidable hospital utilization, and strengthens caregiver resilience. Multidimensional well-being encompasses physical symptom relief, psychological adaptation, social connectedness, and spiritual meaning-making. However, measurement challenges persist, particularly regarding culturally sensitive and system-integrated patient-reported outcome tools. A multilevel integration framework is proposed, embedding well-being across patient, family, community, professional, and policy domains.

Conclusion:
Operationalizing well-being as a measurable health system outcome transforms palliative care from a peripheral service into a foundational pillar of equitable and sustainable healthcare. Embedding multidimensional well-being into clinical workflows, public health monitoring, and universal health coverage strategies offers a pragmatic pathway for realizing WHO’s constitutional vision in contemporary health systems.

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References

Adelman, R. D., Tmanova, L. L., Delgado, D., Dion, S., & Lachs, M. S. (2014). Caregiver burden: A clinical review. JAMA, 311(10), 1052–1060. https://doi.org/10.1001/jama.2014.304

Antunes, B., Harding, R., Higginson, I. J., & EUROIMPACT. (2014). Implementing patient-reported outcome measures in palliative care clinical practice: A systematic review of facilitators and barriers. Palliative Medicine, 28(2), 158–175. https://doi.org/10.1177/0269216313491619

Bakitas, M. A., Tosteson, T. D., Li, Z., Lyons, K. D., Hull, J. G., Li, Z., Dionne-Odom, J. N., Frost, J., Dragnev, K. H., Hegel, M. T., & Ahles, T. A. (2015). Early versus delayed initiation of concurrent palliative oncology care: Patient outcomes in the ENABLE III randomized controlled trial. Journal of Clinical Oncology, 33(13), 1438–1445. https://doi.org/10.1200/JCO.2014.58.6362

Bausewein, C., Daveson, B. A., Benalia, H., Simon, S. T., Higginson, I. J., & PRISMA. (2011). Outcome measurement in palliative care: The essentials. Journal of Pain and Symptom Management, 42(2), 242–257. https://doi.org/10.1016/j.jpainsymman.2011.01.005

Berterame, S., Erthal, J., Thomas, J., Fellner, S., Vosse, B., Clare, P., Hao, W., Johnson, D. T., Mohar, A., Pavadia, J., Samak, A. K., Sipp, W., Sumyai, V., Suryawati, S., Toufiq, J., Yans, R., & Mattick, R. P. (2016). Use of and barriers to access to opioid analgesics: A worldwide, regional, and national study. The Lancet Global Health, 4(12), e889–e897. https://doi.org/10.1016/S2214-109X(16)30307-6

Breitbart, W., Rosenfeld, B., Pessin, H., Applebaum, A., Kulikowski, J., & Lichtenthal, W. G. (2015). Meaning-centered group psychotherapy: An effective intervention for improving psychological well-being in patients with advanced cancer. Journal of Clinical Oncology, 33(7), 749–754. https://doi.org/10.1200/JCO.2014.57.2198

Chochinov, H. M., Hack, T., Hassard, T., Kristjanson, L. J., McClement, S., & Harlos, M. (2009). Dignity in the terminally ill: A developing empirical model. The Lancet Oncology, 3(7), 445–452. https://doi.org/10.1016/S1470-2045(02)00868-7

Chochinov, H. M., Kristjanson, L. J., Breitbart, W., McClement, S., Hack, T., Hassard, T., & Harlos, M. (2011). Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: A randomised controlled trial. The Lancet Oncology, 12(8), 753–762. https://doi.org/10.1016/S1470-2045(11)70153-X

Coast, J., Flynn, T. N., Natarajan, L., Sproston, K., Lewis, J., Louviere, J. J., & Peters, T. J. (2014). Valuing the ICECAP capability index for supportive care measure (ICECAP-SCM). Health Economics, 23(8), 977–991. https://doi.org/10.1002/hec.2964

Bulia, T., Lashkhia, M., Beruchashvili, T., Toidze, O., Abesadze, I., & Sherazadishvili, K. (2025). Palliative care and human choice in dignity. GBMN, 1(1), 105. https://doi.org/10.52340/GBMN.2025.01.01.105

Bulia, T., Beruchashvili, T., Abesadze, I., Abzianidze, E., Dvali, B., & Inaishvili, L. (2025). Palliative care in the 21st century: Multidisciplinary collaboration, digital health, and equitable access. Georgian Scientific Journal, 7(4), 48. https://doi.org/10.52340/gs.2025.07.04.48

Bulia, T., Beruchashvili Lobjanidze, T., Khunjgurua, N., Abesadze, I., Abzianidze, E., Kochalidze, G., Inaishvili, L., & Tatishvili, D. (2026). From suffering to dignity: Redefining palliative care through biopsychosocial, spiritual, and family-centered approaches. Georgian Scientific Journal, 8(1). https://doi.org/10.52340/gs.2026.08.01.03

Holt-Lunstad, J., Smith, T. B., & Layton, J. B. (2010). Social relationships and mortality risk: A meta-analytic review. PLoS Medicine, 7(7), e1000316. https://doi.org/10.1371/journal.pmed.1000316

Huber, M., Knottnerus, J. A., Green, L., van der Horst, H., Jadad, A. R., Kromhout, D., Leonard, B., Lorig, K., Loureiro, M. I., van der Meer, J. W., Schnabel, P., Smith, R., van Weel, C., & Smid, H. (2011). How should we define health? BMJ, 343, d4163. https://doi.org/10.1136/bmj.d4163

Knaul, F. M., Farmer, P. E., Krakauer, E. L., De Lima, L., Bhadelia, A., Kwete, X. J., Arreola-Ornelas, H., Gómez-Dantés, O., Rodriguez, N. M., Alleyne, G. A. O., Connor, S. R., Hunter, D. J., Lohman, D., Radbruch, L., del Rocío Sáenz Madrigal, M., Atun, R., Foley, K. M., Frenk, J., & Jamison, D. T. (2018). Alleviating the access abyss in palliative care and pain relief—An imperative of universal health coverage: The Lancet Commission report. The Lancet, 391(10128), 1391–1454. https://doi.org/10.1016/S0140-6736(17)32513-8

May, P., Normand, C., & Morrison, R. S. (2018). Economic impact of hospital inpatient palliative care consultation: Review of current evidence and directions for future research. Palliative Medicine, 28(3), 181–190. https://doi.org/10.1177/0269216313507482

Parola, V., Coelho, A., Cardoso, D., Sandgren, A., & Apóstolo, J. (2017). Burnout in palliative care settings: A systematic review. Palliative Medicine, 31(7), 613–622. https://doi.org/10.1177/0269216316676685

Smith, T. J., Temin, S., Alesi, E. R., Abernethy, A. P., Balboni, T. A., Basch, E. M., Ferrell, B. R., Loscalzo, M., Meier, D. E., Paice, J. A., Peppercorn, J. M., Somerfield, M., Stovall, E., & Von Roenn, J. H. (2014). American Society of Clinical Oncology provisional clinical opinion: The integration of palliative care into standard oncology care. Journal of Clinical Oncology, 30(8), 880–887. https://doi.org/10.1200/JCO.2011.38.5161

United Nations. (2015). Transforming our world: The 2030 Agenda for Sustainable Development. https://sdgs.un.org/2030agenda

World Health Organization. (1948). Constitution of the World Health Organization. https://www.who.int/about/governance/constitution

World Health Organization. (2014). Strengthening of palliative care as a component of comprehensive care throughout the life course (WHA67.19). https://apps.who.int/gb/ebwha/pdf_files/WHA67/A67_R19-en.pdf

World Health Organization. (2020). Global atlas of palliative care (2nd ed.). https://www.who.int/publications/i/item/9789241565423