한국 의료에서 공유의사결정과 가족

초록

Purpose: In Korean healthcare, decisions about serious illness rarely occur in a patient–clinician dyad. Family members attend explanations, interpret information at home, assess feasibility, and shape deliberation. This narrative review analyzes family involvement in shared decision-making (SDM), focusing on how it supports or undermines patient autonomy and how clinicians can structure roles. Korean- and English-language literature and relevant legal, policy, and guideline sources published or issued from January 2000 to February 2026 were reviewed.Current concepts: When patients want family involvement and roles are explicit, family members can support understanding, recall prior values, manage distress, coordinate care, and assess feasibility. Yet involvement can undermine SDM when family members restrict disclosure, speak for patients without permission, conflate their own preferences or care burdens with patient values, or compensate for care-system gaps in ways that distort decisions. Risks increase when capacity is presumed rather than assessed, family disagreement is unmanaged, or family preferences and care burdens are not distinguished from patient values.Discussion and conclusion: Family involvement in SDM should be designed, not assumed. Clinicians should ask whom patients want involved, when, and for what role; protect the patient’s opportunity to speak; distinguish patient values from family concerns and feasibility constraints; assess capacity, family dynamics, and care burden; use family meetings or ethics consultation for unresolved conflict; and document participants, decisions, communication plans, and reassessment triggers. Family participation is valuable when it keeps the patient’s voice central and the chosen plan workable.

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