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The Korean Society for Journalism & Communication Studies - Vol. 65 , No. 2

[ Article ]
Korean Journal of Journalism & Communication Studies - Vol. 65, No. 2, pp.162-204
Abbreviation: KSJCS
ISSN: 2586-7369 (Online)
Print publication date 30 Apr 2021
Received 11 Dec 2020 Revised 31 Mar 2021 Accepted 12 Mar 2021
https://doi.org/10.20879/kjjcs.2021.65.2.005

쌍방향 균형 커뮤니케이션으로서 공유된 의사결정 시스템 구축을 위한 탐색적 연구 : 신장투석환자의 커뮤니케이션 중심 분석
김수진** ; 안순태*** ; 김세중**** ; 류동열***** ; 김환희******
**이화여자대학교 커뮤니케이션·미디어학부 겸임교수 (sjinkim@ewha.ac.kr)
***이화여자대학교 커뮤니케이션·미디어학부 교수 (soontae@ewha.ac.kr)
****분당서울대학교병원 신장내과 교수 (sejoong2@snu.ac.kr)
*****이화여자대학교 의과대학 내과학교실 교수 (dr6302@gmail.com)
******질병관리청 코로나19 예방접종대응추진단 (hwanheek20@gmail.com)

An exploratory study on the shared decision-making as a two-way symmetrical communication process : focusing on the communication of kidney dialysis patients
Soojin Kim** ; Soontae An*** ; Sejoong Kim**** ; Dong-Ryeol Ryu***** ; Hwanhee Kim******
**Adjunct Professor, Dept. of Communication & Media, Ewha Womans University (sjinkim@ewha.ac.kr)
***Professor, Dept. of Communication & Media, Ewha Womans University, corresponding author (soontae@ewha.ac.kr)
****MD, Professor, Department of Internal Medicine, Seoul National University Bundang Hospital (sejoong2@snu.ac.kr)
*****MD, Professor, Department of Internal Medicine, Medical College, Ewha Womans University (dr6302@gmail.com)
******Korea Disease Control and Prevention Agency, COVID-19 Vaccination Task Force (hwanheek20@gmail.com)
Funding Information ▼

초록

본 연구는 의료현장에서 공유된 의사결정의 개념을 검토하고 쌍방향 균형 커뮤니케이션으로서 공유의사결정 시스템 구축에 영향을 미치는 의사-환자 간 커뮤니케이션 영향 요인을 검토하는데 목적이 있다. 이를 위해 공유의사결정이 필요한 질병 이슈로서 만성콩팥병을 선정하고 만성콩팥병으로 인해 신장투석을 받고 있는 환자 20명을 대상으로 FGI를 진행했다. 투석유형별 환자의 커뮤니케이션 차이, 투석 유형별 환자가 인지하는 의사-환자 간 커뮤니케이션 영향요소 그리고 공유된 의사결정과정에 대한 투석유형별 환자가 인지하는 의사-환자 간 커뮤니케이션을 알아보고자 환자의 일상생활과 관련된 요인, 심리적 요인과 정서적 요인, 혜택과 장애요인과 커뮤니케이션 성향을 질문했다. 인터뷰 결과, 위험인식, 불확실성인식, 커뮤니케이션행동(정보성향), 시간활용과 의사에 대한 태도에서 투석유형별 환자의 차이가 나타났다. 혈액투석환자는 투석방법과 관련된 불확실성, 불편함과 관련된 위험요소를 피하거나 최소화하기 위해 혈액투석방법을 선택하는 경향을 보인 반면, 복막투석환자는 투석방법이 지닌 상대적인 장점과 이점에 기대어 투석방법을 결정하는 경향을 보였다. 혈액투석환자들은 병원에서 의료진에 의한 치료관리에 대한 신뢰 및 안도감을 나타낸 것으로 보아 의료상황에서 직면할 수 있는 불확실성에 대한 반감이 복막투석환자에 비해 상대적으로 높으며 불확실성을 인내하기 보다는 회피하는 것으로 나타났다. 혈액투석환자는 건강 관련 정보를 찾음으로써 치료과정에 적극적으로 개입하고자 하는 정도가 복막투석환자에 비해 상대적으로 낮은 것으로 나타났다. 또한 시간활용이라는 부분은 투석환자에게 있어 큰 중요도가 있는 부분이었다. 혈액투석환자와 복막투석환자 모두 의사에 대한 높은 신뢰를 보였으나 의사를 만날 기회가 잦은 혈액투석환자에 있어 의사는 인생동반자의 의미로, 복막투석환자에게는 일상을 관리해주는 역할 인식이 더 부각되었다. 환자들은 공통적으로 투석방법 결정을 위한 충분한 상담시간의 부족, 주치의가 제공하는 정보의 양적, 질적 한계, 그리고 의료진 외에 투석관련 정보를 얻을 수 있는 경로부재를 커뮤니케이션 한계로 꼽았다. 본 연구는 의사 환자 간 균형적 커뮤니케이션을 바탕으로 공유의사결정의 의미를 연계하고 의료 현장에서 실질적으로 이루어질 수 있는 환자중심의 커뮤니케이션 촉진을 위한 청사진을 제공했다는 데에 학문적인 의미가 있다. 향후에는 의료현장에서 공유의사결정이 필요한 다양한 이슈에 본 논의를 적용함으로써 의사와 환자 그리고 사회가 함께하는 이루어가는 균형적 커뮤니케이션 실천에 대한 노력이 확대되어야 할 것이다.

Abstract

This study is aimed at articulating the concept of shared decision-making in medical encounter and to examine the factors influencing doctor-patient communication as a two-way symmetrical communication process. To this end, chronic kidney disease was selected as a case requiring shared decision-making, and FGI was conducted for 20 patients undergoing kidney dialysis. Three research questions were posed. First, how is the difference in communication among patients according to the kidney dialysis modality? Second, what are the factors that influence doctor-patient communication that patients perceive according to the dialysis modality? Third, what is the difference between doctor-patient communication according to the dialysis modality (hemodialysis, peritoneal dialysis) in the shared decision-making process? Analysis of interviews founds some interesting differences between the patient groups by dialysis modality. It seems that hemodialysis patients tend to choose the dialysis modality in order to avoid or minimize risk factors such as uncertainty and discomfort related to the dialysis method, whereas peritoneal dialysis patients choose the dialysis modality based on the perceived relative advantages of the dialysis method. Hemodialysis patients showed confidence and relief in the management of treatment by medical staff in hospitals, and their ambiguity aversion encountered in medical situations was relatively higher than that of peritoneal dialysis patients. Therefore, it can be said hemodialysis patients are uncertainty avoiders rather than uncertainty tolerators. Hemodialysis patients also showed a relatively lower level of participation in the treatment process by seeking health-related information compared to peritoneal dialysis patients. Both hemodialysis patients and peritoneal dialysis patients showed high trust in doctors. It seems that the doctor is a life companion for the hemodialysis patients since hemodialysis patients visit and see their doctor more frequently and a daily supervisor for the peritoneal dialysis patients who seldom visit and see their doctor. In addition, patients pointed out some communication limitations such as a lack of sufficient communication for decision making of treatment choice, the limited quantity and quality of information provided by the physician, and channel deficiency to obtain dialysis-related information other than medical staff. This study has academic significance in that it provides a blueprint for facilitating patient-centered communication in medical encounters by linking the meaning of shared decision-making based on two-way symmetrical communication between doctors and patients. In the future, by applying various implications from this study to the issues that require shared decision-making in medical encounters, efforts to practice symmetrical communication between doctors, patients, and society should be extended.


Keywords: Shared Decision-Making, SDM, Two-way Symmetrical Communication, Chronic Kidney Disease(CKD), Dialysis Modality
키워드: 공유된 의사결정, 공동의사결정, 쌍방향 균형커뮤니케이션, 만성콩팥병, 투석방법

Acknowledgments

This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number : HC20C0054).(본 연구는 보건복지부의 재원으로 한국보건산업진흥원의 보건의료기술연구개발 사업 지원에 의하여 이루어진 것임(과제고유번호: HC20C0054)).


References
1. Anagnostou, A., Hourihane, J. O’B. & Greenhawt, M. (2020). The Role of Shared Decision Making in Pediatric Food Allergy Management. The Journal of Allergy and Clinical Immunology: In Practice, 8(1), 46-51.
2. Babrow, A. S., Hines, S. C., & Kasch, C. R. (2000). Managing uncertainty in illness explanation: An application of problematic integration theory. Explaining illness: Research, Theory, and Strategies, 41-67.
3. Babrow, A. S., Kasch, C. R., & Ford, L. A. (1998). The many meanings of uncertainty in illness: Toward a systematic accounting. Health Communication, 10(1), 1-23.
4. Brashers, D. E. (2001). Communication and uncertainty management. Journal of Communication, 51(3), 477-497.
5. Brewer, N. T., Chapman, G. B., Gibbons, F. X., Gerrard, M., McCaul, K. D., & Weinstein, N. D. (2007). Meta-analysis of the relationship between risk perception and health behavior: the example of vaccination. Health Psychology, 26(2), 136.
6. Carrotte, E. R., Hartup, M. E., Lee-Bates, B. & Blanchard, M. (2020). “I think that everybody should be involved”: What informs experiences of shared decision-making in supporting people living with schizophrenia spectrum disorders?. Patient Education and Counseling
7. Charles, C., Gafni, A., & Whelan, T. (1997). Shared decision-making in the medical encounter: what does it mean?(or it takes at least two to tango). Social Science & Medicine, 44(5), 681-692.
8. Chen, S. W., Yang, C. C., Te, J. C., Tsai, Y. L., Shorten, B. & Shorten, A. (2021). Birth choices after caesarean in Taiwan: A mixed methods pilot study of a decision aid for shared decision making. Midwifery, 95,
9. Cho, A. R., Kim, J. H., Ko, D. R., Chung, H. S., Shin, Y. S., Kim, J. H. & Cho, J. H. (2019). The effect of lecturing about communication skill with standardized patient for medical students. Health Communication, 15(1), 11-16.
10. Coulter, A., & Collins, A. (2011). Making shared decision-making a reality. London: King's Fund.
11. Coulter, A., & Ellins, J. (2006). Patient-focused interventions: a review of the evidence (Vol. 1). London: Health Foundation.
12. Edwards, A., & Elwyn, G. (2006). Inside the black box of shared decision making: distinguishing between the process of involvement and who makes the decision. Health Expectations, 9(4), 307-320.
13. Elwyn, G., Hutchings, H., Edwards, A., Rapport, F., Wensing, M., & Cheung, W. Y. (2005). The OPTION scale: Measuring the extent that clinicians involve patients in decision-making tasks. Health Expects, 8(1), 34-42.
14. Epstein, R. M., Franks, P., Fiscella, K., Shields, C. G., Meldrum, S. C., Kravitz, R. L., & Duberstein, P. R. (2005). Measuring patient-centered communication in patient–physician consultations: theoretical and practical issues. Social Science & Medicine, 61(7), 1516-1528.
15. Fischhoff, B., Bostrom, A. & Quadrel, M. J. (2013). Risk perception and communication. McGraw-Hill handbook of terrorism and counter-terrorism. New York: McGraw-Hill.
16. Han, H. K. & Kim, J. M. (2011). A Study on the Operation of Blog as a Horizontal Communication Channel between Doctors and Patients : Focusing on in-depth interviews with physician bloggers. Journal of Communication Science, 11(2), 533-562.
17. Hyun, D. W. & Lee, S. Y. (2010). Health 2.0-The New Paradigm of Health Care, Nanam
18. Jo, Y. H. & Ra, J. S. (2019). A Comparative Study of the Importance and Satisfaction of Emergency Room Patient-nurse Communication Needs. Health Communication, 14(1), 1-10.
19. Jo, K. H. (2012). Development and Evaluation of Shared Medical Decision-Making Scale for End-of-Life Patients in Korea. Journal of Korean Academy of Nursing, 42(4), 453-465.
20. Jo, K. H., An, K. J. & Kim, G. M. (2012). Development of Korean Shared Medical Decision-Making Model for Dignified Dying Based on King's Theory. Korean Journal of Medical Ethics, 15(2), 184-205.
21. Jo, K. H. & Kim, G. M. (2014). Types of Shared Medical Decision Making for Terminally Ill Patients. Korean Journal of Hospice and Palliative Care, 17(4), 278-288.
22. Joosten, E. A. G., DeFuentes-Merillas, L., de Weert, G. H., Sensky, T., van der Staak, C. P. F. & de Jong, C. A. J. (2008). Systematic review of the effects of shared decision-making on patietn satisfaction, treatment adherence and health status. Psychotherapy and Psychosomatics, 77, 219-220.
23. Kang, S. J. & Seo, N. S. (2019). A Structural Equation Model on Quality of Life in Hemodialysis Patients. Journal of the Korea Academia-Industrial cooperation Society, 20(7), 589-598.
24. Kaplan, R. M. & Frosch, D. L. (2005). Decision Making in Medicine and Health Care. Annual Review of Clinical Psychology, 1, 525-556.
25. Kehl, K. L., Landrum, M. B., Arora, N. K., Ganz, P. A., Van Ryn, M., Mack, J. W., & Keating, N. L. (2015). Association of actual and preferred decision roles with patient-reported quality of care: shared decision making in cancer care. JAMA oncology, 1(1), 50-58.
26. Kim, H. A., An, B. S. & Kim, Y. H. (2015). The Effect of the Type on Doctor-Patient Communication on Hospital Reputation. Journal of the Korean Advertising & PR Practitioner Society, 8(3), 54-72.
27. Kim. J. K. (2008). Shared Decision-Making as a Model of Medical Decision-Making. Korean Journal of Medical Ethics Education, 11(2), 105-118.
28. Kim, M. (2009). Study on the Factors Influencing Doctor’s Communication Styles: Individual Characteristics and Patient-Centered Trait, Korean Journal of Journalism & Communication Studies, 53(3), 146-172.
29. Kim, M. Y., Lee, J. H. & Doo, E. Y. (2020). Factors Influencing Healthcare Provider-Patient Communication of Patients with Chronic Diseases. Journal of Korean Academy of Nursing Administration, 26(2), 73-83.
30. Kim, S. K. (2010). Medical Ethical Review on Decision Making in Terminal Patient Care. The Catholic Thought, 42, 57-95.
31. Ko, E. K. & Yeo, J. S. (2020). Rights of Healthcare Consumers and Shared Decision-making in Medical Services. Journal of Consumer Studies, 31(2), 49-81.
32. Korea Disease Control and Prevention Agency (2012). Guideline for Prevention and Management of Chronic Kidney Disease. Retrieved 10/12 from http://www.kdca.go.kr/contents.es?mid=a20303020600
33. Kriston, L., Scholl, I., Hölzel, L., Simon, D., Loh, A., & Härter, M. (2010). The 9-item Shared Decision Making Questionnaire(SDM-Q-9). Development and psychometric properties in a primary care sample. Patient Education and Counseling, 80(1), 94-99.
34. Kwon, B. K. (2015). A Survey of Korean Adults’ Understanding of Medical Decision-Making. Korean Journal of Medical Ethics, 18(3), 251-261.
35. Kwon, K. E. (2019). A Study on the Model of life-sustaining treatment Decision Making through Shared Decision Making at the end of life. Journal of the Korean Bioethics Association, 20(1), 45-61.
36. Kushner, B., Holden, T., Politi, M., Blatnik, J. & Holden, S. (2020). A Practical Guideline for the Implementation of Shared Decision-making in Complex Ventral Incisional Hernia Repair. Journal of Surgical Research,
37. Lee, B. H. (2011). A Study on the Communication Barriers between Doctors and Patients. Korean Journal of Communication Studies, 19(1), 35-54.
38. Lee, B. K., Byoun, W. J. & Lim, J. L. (2010). The Influence of Individual’s E-Health Literacy on Doctor-Patient Communication. Journal of Cybercommunication Academic Society, 27(3), 89-125.
39. Lee, E. Y. (2012). Ethical Issues in End-of-Life Decision Making:A New Model for Medical Decisions. Korean Journal of Medical Ethics, 15(2), 160-183.
40. Lee, E. Y. (2014). A Study of Patient Decision Aids (PtDAs) for Shared Decision Making in Medical Decisions. Asia Pacific Journal of Health Law & Ethics, 8(1), 119-140.
41. Lee, E. Y. (2015). Implications of Decision Coaching in Shared Decision Making. Korean Journal of Medical Ethics, 18(2), 200-216.
42. Lee, J. H. & Kim, C. J (2013). Effect of Doctors' Patient-centered Communication on the Patient Satisfaction and Treatment Outcomes : Focusing on Mediating Effect of Patient Participation. Journal of The Korea Contents Association, 13(11), 249-260.
43. Lee, J. S. & Choi, M. K. (2018). The Relationship between Physicians’ Patient-Centered Communication and the Quality of Life of Patients with Chronic Diseases: Focusing on Mediating Effect of Health Behavior. Health and Social Welfare Review, 38(3), 279-302.
44. Lee, N. Y., Lee, S. J. & Lee, S. K. (2016). The Perceptions and Needs of Hospice Palliative Care and Shared Decision Making among Middle-Aged Adults. The Korean Journal of Hospice and Palliative Care, 19(4), 310-321.
45. Lee, Y. H., Lee, Y. M. & Park, Y. K. (2011). Patients’ Expectations of a Good Dentist: The Views of Communication. Health Communication, 6(2), 89-104.
46. Levine, M. N., Gafni, A., Markham, B., & MacFarlane, D. (1992). A bedside decision instrument to elicit a patient's preference concerning adjuvant chemotherapy for breast cancer. Annals of Internal Medicine, 117(1), 53-58.
47. Lin, C. Y., Renwick, L. & Lovell, K. (2020). Patients’perspectives on shared decision making in secondary mental healthcare in Taiwan: A qualitative study. Patient Education and Counseling, 103(12), 2565-2570.
48. Makoul, G. & Clayman, M. L. (2006). An integrative model of shared decision making in medical encounters. Patient Education and Counseling, 60(3), 301-312.
49. McMullan, M. (2006). Patient using the internet to obtain health information: this affects the patient-health professional ing the internet. Patient Education and Counseling, 63(1-2), 24-28.
50. Mishel, M. H. (1988). Uncertainty in illness. Image: The Journal of Nursing Scholarship, 20(4), 225-232.
51. Mishel, M. H. (1990). Reconceptualization of the uncertainty in illness theory. Image:The Journal of Nursing Scholarship, 22(4), 256-262.
52. Na, H. S., Kwon, Y. D. & Noh, J. W. (2013). Development of Physician Coaching Model for Improvement of Patient-Doctor Communication. Journal of The Korea Contents Association, 13(2), 331-340.
53. Park, D. S. (2019). Qualitative Interview Method. Seoul: Communication Books.
54. Plsek, P. (2001). Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC National Academies Pr.
55. R. L. Street, Jr. (2003). Communication in medical encounters: An ecological perspective. In T. Thompson, A. Dorsey, K. Miller, & R. Parrott (eds.), The handbook of health communication (pp. 63~89). Mahwah, NJ: Erlbaum.
56. Robinski, M., Mau, W., Wienke, A., & Girndt, M. (2016). Shared decision-making in chronic kidney disease: a retrospection of recently initiated dialysis patients in Germany. Patient Education And Counseling, 99(4), 562-570.
57. Rosenfeld, B., Breitbart, W., Galietta, M., Kaim, M., Funesti‐Esch, J., Pessin, H., ... & Brescia, R. (2000). The schedule of attitudes toward hastened death: Measuring desire for death in terminally ill cancer patients. Cancer, 88(12), 2868-2875.
58. Rostoft, S., van den Bos, F., Pedersen, R. & Hamaker, M. E. (2020). Shared decision-making in older patients with cancer - What does the patient want?. Journal of Geriatric Oncology,
59. Sanftenberg, L., Kuehne, F., Anraad, C., Jung-Sievers, C. Dreischulte, T. & Gensichen, J. (2021). Assessing the impact of shared decision making processes on influenza vaccination rates in adult patients in outpatient care: A systematic review and meta-analysis. Vaccine, 39(2). 185-196.
60. Seo, N. S. & Sim, E. K. (2020). Influence of Social Support and Health Literacy on Treatment Adherence in Hemodialysis Patients. Journal of the Korea Academia-Industrial cooperation Society, 21(7), 656–666.
61. Søndergaard, S. R., Madsen, P. H., Hilberg, O., Bechmann, T., Jakobsen, E., Jensen, K. M., Olling, K. & Steffensen, K. D. (2020). he impact of shared decision making on time consumption and clinical decisions. Patient Education and Counseling.
62. Suh, W. S. & Lee, C. K. (2010). Impact of Shared-Decision Making on Patient Satisfaction. Journal of Preventive Medicine and Public Health, 43(1), 26-43.
63. Yoo, J. E. (2019). Shared decision-making in Patients with Chronic Disease: Concept Analysis. Journal of the Korea Convergence Society, 10(11), 543-555.
64. Yoon, Y. S., Kim, M. H. & Park, J. H. (2014). Perception of Shared Decision-making and Conflict Decision-making related to Surgery in Elderly Patients with Cancer. Journal of Korean Gerontological Nursing, 16(3), 266-275.
65. Williams, S. J., & Calnan, M. (1996). The ‘limits’ of medicalization?: modern medicine and the lay populace in ‘late’modernity. Social Science & Medicine, 42(12), 1609-1620.

부록
1. 강승자·서남숙 (2019). 혈액투석환자의 삶의 질 구조모형. <한국산학기술학회논문지>, 20권 7호, 589–598.
2. 고은경·여정성 (2020). 의료소비자권리와 공유의사결정에 대한 연구. <소비자학연구>, 제 31권 2호, 49-81.
3. 권경은 (2019). 생애 마지막 단계에서 공유된 의사결정을 통한 연명의료결정 모델 연구. <생명윤리>, 제 20권 제 1호, 45-61.
4. 김미영·이지애·두은영 (2020). 만성질환자의 e-헬스 리터러시가 의료인-환자 커뮤니케이션에 미치는 영향. <간호행정학회지>, 제 26권 제 2호, 73-83.
5. 김민정. (2009). 의사의 커뮤니케이션 스타일에 영향을 미치는 요인 연구: 개인적 특성과 환자 중심적 성향을 중심으로. <한국언론학보>, 53(3), 146-172.
6. 권복규 (2015). 의학적 의사결정에 관한 우리나라 성인의 인식 조사. <한국의료윤리학회지>, 18(3), 251-261.
7. 김성근 (2010). 말기환자 진료에 있어 의사결정에 대한 의료 윤리적 고찰: 의사, 환자, 환자 가족 공동 의사결정을 중심으로. <가톨릭사상>, 제 42호, 57-95.
8. 김진경 (2008). 의학적 의사결정 모델로써 공동의사결정의 이해. <한국의료윤리교육학회지>, 제 11권 제 2호(통권 제 20호), 105-118.
9. 김현아·안보섭·김윤희 (2015). 의사-환자 간 커뮤니케이션 유형이 병원만족도와 병원평판에 미치는 영향: 병원 서비스 품질 인식 매개효과를 중심으로. <광고PR실학연구>, 8권 3호, 54-72.
10. 나현숙·권영대·노진원 (2013). 환자-의사 커뮤니케이션 개선을 위한 의사코칭 모델 개발. <한국콘텐츠학회논문지>, 제 13권 제 2호, 331-340.
11. 박동숙 (2019). 질적 인터뷰 방법. 서울: 커뮤니케이션북스.
12. 서남숙·심은경 (2020). 혈액투석환자의 사회적 지지와 건강정보이해능력이 치료순응도에 미치는 영향. <한국산학기술학회논문지>, 21권 7호, 656–666.
13. 서원식·이채경 (2010). 의사와 환자 간 공유된 진료의사결정이 환자만족도에 미치는 영향. <예방의학회지>, 제 43권 1호, 26-43.
14. 유지연 (2019). 만성질환자의 공유의사결정 개념분석. <한국융합학회논문지>, 10권 11호, 543-555.
15. 윤영신·김명희·박정하 (2014). 노인 암 환자에서 공유의사결정 인식정도와 수술의사결정 갈등 요인. <노인간호학회지>, 제 16권 제 3호, 266-275.
16. 이나연·이승진·이수경 (2016). 중년기 성인의 호스피스 완화의료와 공유의사결정에 대한 인식 및 요구도. <한국 호스피스ㆍ완화의료학회지>, 19권 4호, 310-321.
17. 이병관·변웅준·임주리 (2010). 개인의 e-헬스 리터러시(e-Health Literacy)가 의사-환자 커뮤니케이션에 미치는 영향. <사이버커뮤니케이션학보>, 제 27권 제 3호, 89-125.
18. 이병혜 (2011). 의사-환자 간의 의사소통 장애요인 인식 차이와 소통만족도에 미치는 영향. <커뮤니케이션학연구>, 19권 1호, 35-54.
19. 이영희·이영미·박영국 (2011). 환자가 기대하는 좋은 치과의사: 커뮤니케이션 측면을 중심으로. <의료커뮤니케이션>, 제 6권 제 2호, 89-104.
20. 이은영 (2012). 삶의 마감 시기 의사결정의 윤리적 이슈-의사결정 모델 제안을 중심으로. <한국의료윤리학회지>, 제 15권 제 2호, 160-183.
21. 이은영 (2014). 의학적 의사결정으로써 공동의사결정 실현을 위한 환자의사결정도구(PtDAs) 연구. <생명윤리정책연구>, 제 8권 제 1호, 119-140.
22. 이은영 (2015). 공동의사결정에서의 의사결정 코칭(Decision Coaching)의 함의. <한국의료윤리학회지>, 제 18권 제 2호, 200-216.
23. 이정선·최만규 (2018). 의사의 환자 지향적 커뮤니케이션과 만성질환자의 삶의 질과의 관계: 건강행태의 매개효과를 중심으로. <보건사회연구>, 38권 3호, 279-302.
24. 이종학·김찬중 (2013). 의사의 환자중심 커뮤니케이션이 환자만족과 치료성과에 미치는 영향. <한국콘텐츠학회논문지>, 제 13권 제 11호, 249-260.
25. 조계화 (2012). 한국형 공유 의료적 의사결정 측정 도구 개발 및 평가. <대한간호과학회지>, 제 42권 제 4호, 453-465.
26. 조계화·김균무 (2014). 말기 환자의 공유 의료적 의사결정에 관한 의료인의 인식 유형. <한국 호스피스ㆍ완화의료학회지>, 제 17권 제 4호, 278-288.
27. 조계화·안경주·김균무 (2012). 킹의 이론에 근거한 공유된 한국형 의료적 의사결정 모델. <한국의료윤리학회지>, 제 15권 제 2호(통권 제34호). 184-205.
28. 조아라·김지훈·고동률·정현수·신용숙·김지혜·조준호 (2019). 의과대학 학생에게 표준화 환자와의 의사 소통을 대형 강의로 가르친 효과. <의료커뮤니케이션>, 15권 1호, 11-16.
29. 조윤희·라진숙 (2019). 응급실 환자-간호사 간 간호사의 의사소통 수행에 대한 중요도와 만족도 비교. <의료커뮤니케이션>, 14권 1호, 1-10.
30. 질병관리본부 (2012). 만성콩팥병 예방과 관리를 위한 9대 생활 수칙. Retrieved 10/12 from http://www.kdca.go.kr/contents.es?mid=a20303020600
31. 한혜경·김주미 (2011). 의사-환자 간 수평적 커뮤니케이션 채널로서 블로그 운영에 관한 연구. <언론과학연구>, 제 11권 2호, 533-562.
32. 현대원ㆍ이수영 (2010), 『헬스 2.0-헬스케어의 새로운 패러다임』, 나남
33. 대한신장학회 자료집(2020) http://www.ksn.or.kr/e_book/20190926/ecatalog5.html
34. 대한신장학회 자료집(2019) http://www.ksn.or.kr/e_book/202009/ecatalog5.html
35. 보건복지부 자료집(2020) http://www.mohw.go.kr/react/jb/sjb030301vw.jsp