Factors contributing to limited patient involvement in physician-patient communication in South Korea: A qualitative study

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.