https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/485 2026-07-04T11:41:33Z https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/212533 Title: Multilevel barriers and facilitators of shared decision-making in chronic illness management: a social ecological model approach Authors: Bae, Go Eun; Lee, Jinyoung; Yoo, Sang-Ho; Jang, Sou Hyun Abstract: Background: Shared decision-making is central to patient-centered chronic illness care, yet patients’ participation often remains constrained in physician-driven systems. Therefore, this study applied the Social Ecological Model to explore how multilevel barriers and facilitators influence patient–doctor communication and shared decision-making among patients with chronic illnesses. Methods: We conducted an interpretive qualitative study in South Korea using semi-structured, in-depth interviews guided by the Social Ecological Model. Sixteen adults diagnosed with hypertension, diabetes mellitus, chronic kidney disease, or heart disease for more than 12 months were purposively sampled. Interviews (75–115 min) were transcribed verbatim and analyzed using qualitative content analysis informed by grounded theory approaches. Codes were inductively developed through open coding and organized across multiple ecological levels (individual, interpersonal, institutional, societal). Analytical rigor was enhanced through independent coding, iterative discussions, and triangulation. Results: Twelve themes were identified across multiple levels. At the individual level, patients’ illness-specific perceptions, health literacy, and psychological distress strongly influenced engagement. At the interpersonal level, physician authority, limited and selective information provision, and patients’ own communication styles shaped relational dynamics, which together determined trust and willingness to participate. The institutional level was marked by hospital capacity and continuity challenges, outdated or inaccessible educational resources, and rigid scheduling and coordination processes that constrained dialogue. Cultural expectations of deference to physicians, entrenched hierarchical medical culture, and financial uncertainty (including lack of transparent cost information) further limited autonomy at the societal level. Across levels, empathetic provider communication and supportive information environments functioned as key facilitators. Conclusions: Shared decision-making in chronic illness care is not solely a patient–provider exchange but the product of interacting personal, relational, organizational, and societal forces. Effective promotion of shared decision-making requires multilevel interventions: strengthening patients’ knowledge and self-efficacy, fostering empathetic two-way communication, ensuring institutional continuity and educational support, and addressing structural and cultural barriers. By aligning strategies across these levels, health systems can enable patients to participate as informed and autonomous partners in decision-making, ultimately improving care quality and outcomes. Clinical trial registration: Not applicable. 2026-12-01T00:00:00Z https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/212730 Title: Factors contributing to limited patient involvement in physician-patient communication in South Korea: A qualitative study Authors: Park, Yeori; Park, Young Su; Kim, Yeonju; Kang, Jiyeon; Yoo, Sang-Ho Abstract: Objectives: This study examined how Korean cancer patients and family members exhibit internalized self-regulation that contributes to their limited participation in medical consultations and reluctance to engage in decision-making. The research question focused on identifying structural and cultural factors that shape patient passivity in cancer-related physician-patient communication. Methods: A qualitative study was conducted using semi-structured, in-depth interviews. Data were analyzed thematically following Braun and Clarke's approach to identify recurrent patterns and emergent themes. A total of 30 interview participants were selected. Fifteen patients with cancer participated in the study, as well as fifteen family members who care for cancer patients (26 women and 4 men; ages 30–79). Inclusion criteria were being diagnosed with cancer, having received treatment in a university-affiliated hospital, and the ability to communicate in Korean. No restrictions were imposed regarding cancer type or stage. Results: The analysis revealed three overarching dimensions of internalized self-regulation shaping patients and caregivers’ reluctance to actively participate in communication: (1) self-regulation driven by an information gap, encompassing trust in physician expertise and self-doubt regarding medical knowledge; (2) internalized time pressure, reflecting patients and caregivers’ perceptions of physicians’ busyness and reluctance to extend consultations; and (3) self-censorship rooted in the medicine–personal divide, whereby patients and caregivers distinguished between acceptable medical questions and those relegated to the personal domain. These patterns illustrate how social authority, clinical structures, and cultural meanings of cancer reinforce patients’ passivity in decision-making. Conclusions: Korean cancer patients and their family members often regulate their own participation in physician-patient communication through self-doubt, deference, and self-censorship, leading to limited involvement in decision-making. Practice implications: To enhance patient-centered care, clinicians should provide clear information early, explicitly invite questions, and foster a supportive consultation environment. In addition, both patients and physicians should receive training programs that ensure adequate medical information and facilitate effective communication. 2026-08-01T00:00:00Z https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/212879 Title: Experiences, perceptions and preferences regarding medical decision-making in South Korea: a nationwide cross-sectional survey of the general public Authors: Kim, Min Ji; Yoo, Sang Ho Abstract: Objectives Active patient involvement is a core principle of patient-centred care, yet public experiences of medical decision-making in non-Western settings remain underexamined. In South Korea, nationwide evidence on how adults experience, perceive and prefer medical decision-making is limited. This study, therefore, examined Korean adults' experiences, perceptions and preferences regarding medical decision-making. Design A cross-sectional study was conducted between March and April 2025 using online data collection for adults aged 19-59 years and face-to-face interviews for those aged 60 years or older. Setting This nationwide survey was conducted in South Korea. Participants A total of 1081 Korean adults were recruited using proportional quotas for sex, age group and region. After excluding withdrawals and invalid responses, 1000 were included (response rate 92.5%). Results Overall, 70.4% of respondents reported at least one significant health-related decision in the past 2 years. Although 34.1% reported making their most recent decision independently, a larger proportion preferred collaborative decision-making involving clinicians and/ or family members. The clinician's explanation was the most influential factor (77.4%). Preferences for primary decision-maker varied by clinical context: patient-led decisions were favoured for low-risk interventions such as vaccination (78.5%), whereas physician involvement was preferred for life-threatening illness (86.2%). Communication ratings were highest for presentation of treatment options (mean score 3.56 +/- 0.79 on a 5-point scale) and lowest for explanation of potential treatment risks (mean score 3.20 +/- 0.89). Participants satisfied with decision outcomes reported higher communication quality (p<0.001), while those reporting neutral satisfaction (37.1%) resembled dissatisfied participants (4.1%). Conclusions Medical decision-making was common, but respondents' experiences did not always match their preference for collaborative involvement. The findings suggest that strengthening patient-centred care in South Korea will require not only improvements in patient-clinician communication, but also attention to family involvement and structural conditions such as limited consultation time and current reimbursement arrangements. 2026-05-01T00:00:00Z https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/210718 Title: A systematic review of the effects of shared decision-making in the South Korean healthcare system Authors: Yun, Hyunok; Woo, Kyung-Sook; Lee, Do-young; Yoo, Sang-Ho Abstract: Introduction: Shared decision-making (SDM) is a collaborative process that improves patient-centered care and has been widely adopted across healthcare systems internationally. Despite increasing attention, SDM remains underutilized in South Korea, and systematic evidence on its implementation and effectiveness is limited. This study systematically reviewed SDM programs implemented in South Korea, assessed their effectiveness, and aimed to inform the development of context-specific models for broader integration into healthcare practice. Methods: This study employed the ECLIPSE (Expectations, Client groups, Location, Impact, Professionals, Services) framework to refine the research questions and conducted a systematic search across seven international and domestic databases, as well as Google Scholar for studies published until July 2024. Eligible studies included quantitative designs that assessed the outcomes of SDM interventions. Study quality was assessed using the QualSyst tool, and a narrative synthesis was conducted due to the heterogeneity in study designs and outcome measures. Results: Of the 14 included studies 13 addressed information provision, 8 involved patient participation, 7 incorporated decision-making processes, and only 3 integrated all core SDM components. Outcomes were reported across three domains: Affective-cognitive (e.g., satisfaction, decisional conflict, knowledge), behavioral (e.g., intention to act), and clinical (e.g., quality of life). SDM was associated with increased patient satisfaction (in 10 out of 14 studies), reduced decisional conflict (in 8 studies), and improved patient knowledge (in 9 studies). However, variations in effectiveness were observed depending on patient characteristics, healthcare settings, and the design and delivery of interventions. Conclusion: This review highlights the potential of SDM to enhance patient-centered care in South Korea. However, inconsistencies in intervention components and evaluation methodologies limit the generalizability of the findings. Given the unique features of the Korean healthcare system-such as very short consultation times, limited reimbursement for counseling, and provider-patient information asymmetry-future research should focus on developing SDM models tailored to these constraints and cultural contexts, supported by appropriate evaluation tools and policy measures.Systematic review registration https://www.crd.york.ac.uk/PROSPERO (CRD42024582894). 2026-01-01T00:00:00Z