Journal of Hospice and Palliative Care

Korean Society for Hospice and Palliative Care (한국호스피스완화의료학회)
권호 표지
DOI QR코드

DOI QR Code

Types of Shared Medical Decision Making for Terminally Ill Patients

말기 환자의 공유 의료적 의사결정에 관한 의료인의 인식 유형

  • Jo, Kae Hwa (Department of Nursing, Catholic University of Daegu School of Medicine) ;
  • Kim, Gyun Moo (Department of Emergency Medicine, Catholic University of Daegu School of Medicine)
  • 조계화 (대구가톨릭대학교 간호대학) ;
  • 김균무 (대구가톨릭대학교 의과대학 응급의학교실)
  • Received : 2014.09.17
  • Accepted : 2014.11.12
  • Published : 2014.12.01
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: The purpose of this study is to analyze types of shared medical decision making by health professionals in a decision making position. Methods: The Q-methodology was used. Q sample was constructed with a total of 35 Q-statements that were offered with a 9-point rating scale. The statements were structured to generate answers that would form a shape of a normal distribution. Answers to Q sample were analyzed using a QUANL PC program. Results: Four types of shared medical decision making were identified. Type I is patient-centered decision making, Type II is physician-centered, Type III is health professional-centered and Type IV is patient-family-centered. Conclusion: Study results indicate that it is recommended to develop an education program based on the four types of shared medical decision making so that health professionals can be provided with different approaches according to their decision making style.

목적: 의료가 복잡하고 전문화된 최근에는 의료학문간 소통과 융합이 강조되고 있다. 병원업무는 환자를 중심으로 여러 분야의 협동 체계를 통한 의사결정의 효율성이 요구된다. 이 논문은 말기 환자에 대한 의사와 간호사의 공유 의료적 의사결정에 대한 인식을 알아보고자 한다. 방법: Q 방법론을 적용하여 35개의 Q 진술문을 9점 척도의 정규분포로 39명에게 작성하도록 하였다. 수집된 자료는 QUANL PC 프로그램으로 분석하였다. 결과: 환자결정형, 의사결정형, 의료인 공유결정형, 환자 가족 결정형의 네 가지 유형으로 나타났다. 공통적으로 동의한 항목은 충분한 설명과 치료과정의 공유, 교육 등으로 나타났고, 부정적으로 생각한 항목은 치료에 법적 측면을 고려에 대한 내용이었다. 제1유형은 환자의 요구와 가치관을 존중하는 환자중심의 의사결정 방식을, 제2유형은 의사가 결정을 내리고 환자가 이를 따르는 방식을, 제3유형은 의료인 상호간의 협력적인 의사 공유를, 제4유형은 의료인뿐 아니라 가족 참여의 의사결정을 중요하게 생각하였다. 결론: 의료인 간의 생각이 다양하다는 것을 보여주며, 일반인과도 의견의 차이를 보여준다. 의사결정에 대한 의견의 공유와 추가적인 연구가 필요할 것으로 생각된다.

Keywords

References

  1. Frank RK. Shared decision making and its role in end of life care. Br J Nurs 2009;18:612-8. https://doi.org/10.12968/bjon.2009.18.10.42466
  2. Briggs L, Colvin E. The nurse's role in end-of-life decision-making for patients and families. Geriatr Nurs 2002;23:302-10. https://doi.org/10.1067/mgn.2002.130271
  3. Lee SM, Kim SY, Lee HS. The process of medical decisionmaking for cancer patients. Korean J Med Ethics 2009;12:1-14.
  4. Jo KH. Development and evaluation of shared medical decisionmaking scale for end-of-life patients in Korea. J Korean Acad Nurs 2012;42:453-65. https://doi.org/10.4040/jkan.2012.42.4.453
  5. Groselj U, Orazem M, Kanic M, Vidmar G, Grosek S. Experiences of slovene ICU physicians with end-of-life decision making: a nation-wide survey. Med Sci Monit 2014;21:2007-12.
  6. Obeidat RF, Homish GG, Lally RM. Shared decision making among individuals with cancer in non-Western cultures: a literature review. Oncol Nurs Forum 2013;40:454-63. https://doi.org/10.1188/13.ONF.454-463
  7. Jo KH, An GJ, Kim GM. Future changes and directions for the construction of a medical decision-making system in Korea: focused on delphi surveys. Korean J Med Ethics 2011;14:131-44.
  8. Byun EK, Choi HR, Choi AL, Kim NM, Hong KH, Kim HS. An investigative research on the attitudes of intensive care unit nurses and families on terminating life support. Clin Nurs Res 2003;9:112-24.
  9. Corless IB, Nicholas PK, Nokes KM. Issues in cross-cultural quality-of-life research. J Nurs Scholarsh 2001;33:15-20. https://doi.org/10.1111/j.1547-5069.2001.00015.x
  10. Kim HG. Understanding of Q methodology for subjectivity Research. The Seoul J of Nursing 1992;6:1-11.
  11. Johnston B, Smith LN. Nurses' and patients' perceptions of expert palliative nursing care. J Adv Nurs 2006;54:700-9. https://doi.org/10.1111/j.1365-2648.2006.03857.x
  12. Hilden HM, Honkasalo ML. Finnish nurses' interpretations of patient autonomy in the context of end of life decision making. Nurs Ethics 2006;13:41-51. https://doi.org/10.1191/0969733006ne856oa
  13. Jo KH. Nurse's conflict experience toward end-of-life medical decision-making. J Korean Acad Adult Nurs 2010;22:488-98.
  14. Edwards A, Elwyn G. Inside the black box of shared decision making: distinguishing between the process of involvement and who makes the decision. Health Expect 2006;9:307-20. https://doi.org/10.1111/j.1369-7625.2006.00401.x
  15. Reeves S, Freeth D, Glen S, Leiba T, Berridge EJ, Herzberg J. Delivering practice-based interprofessional education to community mental health teams: Understanding some key lessons. Nurs Educ Pract 2006;6:246-53. https://doi.org/10.1016/j.nepr.2006.02.001
  16. Suh WS, Lee CK. Impact of shared-decision making on patient satisfaction. J Prev Med Public Health 2010;43:26-34. https://doi.org/10.3961/jpmph.2010.43.1.26
  17. Cassanova J, Day K, Dorpat D, Hendricks B, Theis L, Wiesman S. Nurse-physician work relations and role expectations. J Nurs Adm 2007;37:68-70. https://doi.org/10.1097/00005110-200702000-00007
  18. Jo KH, An GJ, Kim GM, Kim YJ. Predictive factors for city Dwellers' attitudes toward death with dignity. Korean J Hosp Palliat Care 2012;15:193-204.

Cited by

  1. Perception of Vocational Rehabilitation Counselors about Happiness of People with Disabilities vol.18, pp.1, 2016, https://doi.org/10.21075/kacsn.2016.18.1.27
  2. An exploratory study on the shared decision-making as a two-way symmetrical communication process : focusing on the communication of kidney dialysis patients vol.65, pp.2, 2014, https://doi.org/10.20879/kjjcs.2021.65.2.005