류마티스질환에서의 공유의사결정: 모델, 실제, 그리고 미래 방향

Abstract

Purpose: Shared decision-making (SDM) plays a critical role in the clinical management of patients with rheumatic diseases, where long-term disease control, multiple therapeutic options, and variable patient responses require individualized and collaborative treatment planning. This review examines 3 representative SDM models—the 3-talk model, SHARE, and SEED—and evaluates their applicability to rheumatology, with particular emphasis on treatment decisions involving targeted therapies in rheumatoid arthritis and ankylosing spondylitis. Current Concepts: Several structured models have been developed to support the SDM process in clinical practice. These models highlight different aspects of physician–patient interaction, including recognition of decision points, information exchange, clarification of patient values, and achievement of consensus on treatment plans. Although growing international evidence demonstrates SDM’s benefits in improving adherence, satisfaction, and patient engagement, its application in Korean clinical practice remains limited. Structural and cultural barriers, such as time constraints, hierarchical communication, and insufficient system support, must be addressed before SDM can be widely implemented. Discussion and Conclusion: Effective SDM requires a multidisciplinary approach that combines physician communication training, patient education, and the integration of well-developed decision aids into routine practice. In parallel, institutional and policy-level measures are needed to ensure adequate consultation time and sufficient system capacity. Developing an SDM model contextualized for Korea and evaluating its effectiveness through clinical research will be essential. Ultimately, SDM should not be regarded merely as a communication technique, but as a strategic and practical framework to enhance quality of care in rheumatology and to promote patient-centered treatment decisions.