A systematic review of the effects of shared decision-making in the South Korean healthcare system

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).