Physicians' perceptions, reported experience, and perceived structural barriers to shared decision-making in South Korea: a multispecialty survey

Shared decision-making (SDM) is a health communication practice that supports patient participation and aligns care with patients' values. Routine implementation depends on clinicians' familiarity and communication practices as well as consultation time, workflow, organizational support, and financing. In this study, we examined physicians' perceptions of patient and professional roles, reported familiarity and experience with SDM, associated physician and practice characteristics, and perceived priorities for wider implementation in South Korea.

We conducted a nationally distributed, non-probability, volunteer, web-based cross-sectional survey from April 3 to August 31, 2025. This pragmatic design was used because no comprehensive sampling frame was available and the study sought professionally and geographically diverse responses. Eligible participants self-reported a Korean medical license and at least 1 year of clinical experience. Recruitment used academic societies, professional associations, web postings, email distributions, and professional networks. Analyses included descriptive statistics, paired t-tests, chi-square tests, and modified Poisson regression with robust variance estimation.

Of 709 screening entries, 542 complete, eligible, non-duplicate questionnaires were analyzed. Respondents rated both physicians' views (mean 4.68, SD 0.57) and patients' views (mean 4.64, SD 0.59) highly in their own decision-making; physicians' explanations received the highest rating among the predefined factors (mean 4.71, SD 0.60). Self-ratings of patient-centered communication and decision-making practices exceeded ratings of physicians in general (mean differences 0.22-0.27; all p < 0.001), but effect sizes were small (Cohen's d = 0.25-0.29). Overall, 366 (67.5%) respondents reported having heard of SDM, 270 (49.8%) reported experience with SDM, and 211 (38.9%) rated their understanding as high or very high. Reported SDM term awareness was associated with self-reported experience (adjusted prevalence ratio 2.32, 95% CI 1.74-3.08; p < 0.001). Among 200 respondents who rated implementation as neutral or less feasible, 157 (78.5%) prioritized environmental factors.

Support for patient participation coexisted with substantial professional input, while reported familiarity and experience with SDM were not universal. Among respondents uncertain about implementation, structural conditions were the dominant perceived priority. Because volunteer sampling, self-report, and the cross-sectional design limit generalizability and causal inference, the policy implications are hypothesis-generating and require evaluation using representative, validated, observational, and longitudinal approaches.