대한신장학회

논문분류	춘계학술대회 초록집
제목	Shared decision making for elderly patients with CKD
저자	Byung Chul Yu
출판정보	2021; 2021(1):
키워드
초록	Shared decision-making (SDM) has been defined as a process by which patients and health care providers share the best available evidence and contribute to making a medical decision under mutual agreement. Patients and physicians ponder and make decisions together on the appropriate treatment, sharing responsibility for the final decision. Since Veatch introduced the new concept of “sharing of decision-making” in 1972, many studies on the efficacy of SDM in clinical practice have been conducted. Medical SDM has been associated with improvement of treatment compliance, patient satisfaction, and patient quality of life. In addition, SDM improves patients’ knowledge of treatment options and reduces conflict in the decision-making process related to uncertainty about their own values. Moreover, it encourages patients to play a more active role in the decision-making process and improve their awareness of associated risks. Systematic reviews of SDM-related patient preferences and physicians’ perceptions revealed that interest in SDM is increasing now compared to the past, with SDM being the preferred decision- making method of most patients and physicians. As evidence of ethical adequacy and clinical effectiveness accumulates, many countries are policing the SDM approach as a decision-making method. One of the most critical topics in end-of-life care including life-sustaining treatment in nephrology is related to the starting, withholding, and withdrawal of dialysis; various studies have been conducted on this topic. In the dialysis treatment decision process, it has been reported that sufficient information exchange and sharing of the decision process between the doctor and the patient were associated with less regret of the patients with regard to the decision-making. This is consistent with the direction SDM is pursuing and may be the reason for the need to establish appropriate SDM in the field of nephrology. Various strategies for effective adoption and application of SDM have been studied; among them, SDM education for health care professionals has been the most studied, and although its effectiveness has shown heterogeneous results, it is known to be a relatively effective method. Recent study showed that when the curriculum using standardized patients to teach the main concepts and techniques of SDM was applied to internal medicine residents, knowledge, attitude, and application ability of SDM were improved. Previous studies showed that the majority of physicians cited the lack of time as the major obstacles to its proper application. A new scheduling algorithm that can properly allocate interview time for decision-making and an information system that actively supports physicians could also be considered viable options. Policymakers should expend effort into developing policies that support allocating meaningful time for appropriate SDM.
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