Health Care Professional Factors Influencing Shared Medical Decision Making in Korea

Hong Seon Lee,Kae-Hwa Jo,Gyeong-Ju An

doi:10.1177/2158244015614608

Abstract

Till date, the medical decision-making process in Korea has followed the paternalist model, relying on the instructions of physicians. However, in recent years, shared decision making at the end-of-life between physicians and nurses is now emphasized in Korea. The purpose of this study was conducted to explore how health care professionals’ characteristics, attitude toward dignified dying, and moral sensitivity affect their shared medical decision making. The design was descriptive survey. This study was undertaken in two university hospitals in two metropolitan cities, South Korea. The participants were 344 nurses and 80 physicians who work at university hospitals selected by convenience sampling method. Data were collected from January 10 through March 20, 2014 using the Dignified Dying Scale, Moral Sensitivity Scale, and Shared Medical Decision-Making Scale. Shared medical decision making, attitude toward dignified dying, moral sensitivity, age, and working experience had a significant correlation with each other. The factors affecting shared medical decision making of Korean health care professionals were moral sensitivity and attitude toward dignified dying. These variables explained 22.4% of the shared medical decision making. Moral sensitivity and a positive attitude toward dignified dying should be promoted among health care professionals as a part of an educational program for shared medical decision making.

Highlights

As our contemporary society has extended its focus beyond well-being to well-dying, the health care system has turned its attention to physicians’ decision making in accommodating the process of end-of-life care, such as issuing advance directives and withdrawing treatment from individuals in view of the right to die with dignity (Jo, 2011)
As the concept of death is connected to life integration (Wilson, Coenen, & Doorenbos, 2006), these characteristics of nursing education emphasize the social aspects of human psychology and Erikson’s theory through the taking of humanities courses, presumably creating a strong awareness of human dignity in Korean nurses
The main factors affecting shared medical decision making were shown to be the attitude toward dignified dying and moral sensitivity

Summary

Introduction

As our contemporary society has extended its focus beyond well-being to well-dying, the health care system has turned its attention to physicians’ decision making in accommodating the process of end-of-life care, such as issuing advance directives and withdrawing treatment from individuals in view of the right to die with dignity (Jo, 2011). End-of-life decision-making process has not evolved beyond the traditional culture of physicians’ paternalism due to the physician’s duty toward beneficence and nonmaleficence (Jo, An, & Kim, 2012). The medical decision-making process in Korea has followed the paternalist model, relying on the instructions of physicians (Lee, Kim, & Lee, 2009). In recent years, shared decision making between physicians and nurses regarding end-of-life care is emphasized in Korea. The paradigm of the medical decision-making approach has been changed with the recent development of the shared medical decision-making model (Jo, 2011)

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