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The Korean Society for Journalism & Communication (KSJCS)
[ Article ]
Korean Journal of Journalism & Communication Studies - Vol. 65, No. 2, pp.162-204
ISSN: 2586-7369 (Online)
Print publication date 30 Apr 2021
Received 11 Dec 2020 Accepted 12 Mar 2021 Revised 31 Mar 2021
DOI: 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

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)).

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