Shared decision-making (SDM) is a process in which patients and healthcare providers discuss available options and collaboratively make medical decisions based on mutual agreement (1). Introduced by Veatch to emphasize patient rights in healthcare (2), SDM has been implemented primarily in clinical practice in Western countries since the 1990s. It is widely recognized as a core component of patient-centered care (3) and a method for enhancing the quality of decision-making through improved communication (1). Many studies have shown that patient engagement through SDM improves medication adherence, physical health, quality of life (QoL), and satisfaction with services, while also reducing hospital and emergency department admissions (4–8). SDM has further been shown to enhance patients’ knowledge of treatment options and reduce conflicts related to patient preferences and value-based decision-making (9).

As evidence supporting the ethical, clinical, and practical value of SDM continues to accumulate, several countries—such as Germany, the United Kingdom, and the Netherlands—have institutionalized SDM through national policies and healthcare regulations (10–12). Additionally, countries including the United States (13–15), Japan (16, 17), China (18, 19), Saudi Arabia (20, 21), and Ethiopia (22, 23) are actively conducting national-level literature reviews to evaluate their implementation, key outcomes, and contextual applicability as part of efforts to expand and formalize SDM practices.

A review of SDM implementation and outcomes within individual countries highlights several key insights. Evidence indicates that SDM and PtDAs can reduce or sustain healthcare costs and utilization without impairing preventive care (14). SDM also supports the transition to value-based care and improves patient engagement, satisfaction, and health outcomes across diverse populations (15). In cancer screening, SDM combined with decision aids enhances patient knowledge, promotes informed choices, and reduces decisional conflict, enabling more personalized participation (16). Additional reviews identify factors affecting SDM adoption, such as patient, provider, and health system variables, and recommend efforts to enhance health literacy and provide targeted support and training for effective SDM use (20–23).

In South Korea, the adoption of SDM remains limited despite the increasing recognition of its importance. Although the Life-Sustaining Treatment Decisions Act was enacted in 2018, allowing patients or their legal representatives to determine whether to discontinue or withhold life-sustaining treatments (24), there are no laws or systems explicitly incorporating the concept of SDM. This policy gap continues to hinder stable integration and widespread implementation in clinical practice. Furthermore, several substantial challenges impede effective communication between healthcare providers and patients. Chief among these issues are the brief consultation durations and inadequate remuneration for medical services within the Korean healthcare system. The current reimbursement structure does not sufficiently compensate for patient counseling, resulting in the normalization of so-called “3-min consultations.” Such time constraints place a significant burden on healthcare providers and serve as a barrier to implementing SDM. Additionally, the asymmetry of information and knowledge—where providers possess more expertise than patients—creates a power imbalance that further obstructs patient engagement in decision-making. Given these circumstances, the urgent need to adopt SDM is evident, as it has the potential to significantly enhance patient participation and improve communication dynamics within the Korean healthcare setting (25).

The increasing awareness of the importance of patient participation in the treatment process has led to progress in implementing SDM through collaboration between patients and healthcare providers in specific clinical areas of Korea. Since the mid-2010s, SDM has been piloted and gradually expanded across various clinical settings, particularly in oncology (26, 27), with several experimental studies investigating its effects on patient outcomes (28–30). More recently, in 2023, the South Korean government launched a four-year national research initiative titled “Shared Decision-Making between Patients and Physicians,” funded by the Ministry of Health and Welfare, reflecting growing institutional recognition of the importance of SDM in clinical practice (31).

Despite these developments, no systematic review has yet been conducted on South Korean studies that provide an overview of SDM implementation programs and assess their effectiveness. Considering international policy advancements and the expanding body of SDM research, a comprehensive evaluation of SDM implementation and impact within the South Korean healthcare system is urgently needed. Such an assessment will provide critical insights into the current status, benefits, limitations, and contextual challenges of SDM in South Korea. A scientifically grounded synthesis of the evidence will support informed policy decisions, including the development of a South Korea-specific SDM model and the design of pilot programs for potential integration into national health insurance coverage. In evaluating the impact of SDM interventions, patient outcomes extend beyond clinical health indicators to encompass cognitive, affective, and behavioral aspects of the patient experience. Therefore, this review adopted the conceptual classification of patient outcomes proposed by Shay and Lafata (32), which organizes outcomes into affective–cognitive, behavioral, and health-related domains.

This study systematically reviewed SDM programs implemented in South Korean healthcare, summarized their core features and outcomes, and assessed their impact across various healthcare settings, patient populations, and healthcare professionals.

This systematic review synthesized 14 empirical studies on SDM in South Korea, evaluating their implementation across diverse clinical settings and their effects on patient outcomes. While most studies addressed individual elements such as information provision and patient participation, only a few incorporated all core SDM components—namely, information provision, patient participation, communication, and decision-making—or were guided by established theoretical frameworks. These findings suggest that SDM may improve patient outcomes, although limitations in intervention delivery and outcome assessment remain widespread.

Consistent with trends in the international literature (57), SDM interventions in South Korea have been most frequently applied in oncology and chronic care settings, where treatment decisions often involve multiple viable options and require value-sensitive trade-offs that are best addressed by incorporating patients’ unique values and preferences (58).

Cognitive outcomes were the most commonly assessed across the included studies, encompassing satisfaction, decisional conflict, knowledge, and attitudes. Consistent with previous reviews (58, 59), SDM was positively associated with improvements in affective–cognitive outcomes such as increased patient satisfaction, enhanced knowledge, and reduced decisional conflict. However, some studies reported no association or even negative effects, depending on the SDM components, types of decision aids used, and participant characteristics—indicating inconsistencies in the overall evidence.

Several factors may explain the inconsistencies in patient outcomes observed across studies. A key contributor is the heterogeneity of SDM interventions. Studies varied substantially in the SDM components they included, ranging from primarily providing information to integrating more comprehensive elements such as patient participation, shared deliberation, and decision aids. Consistent with reviews from other countries facing similar challenges in early SDM implementation (18, 19), this study highlights a limited understanding of the SDM concept in South Korea. Second, differences in outcome measurement across studies could have contributed to the inconsistent results. Studies used a variety of instruments to measure cognitive outcomes, including satisfaction and decisional conflict. This underscores the need for reliable and standardized instruments to enable consistent assessment and foster a shared framework among researchers and healthcare professionals (60). Third, methodological ambiguities or design limitations, including small sample sizes, a lack of control groups, or high attrition rates, may have affected the validity and reliability of the findings (61). These limitations make it difficult to draw firm conclusions about the effectiveness of SDM interventions and highlight the need for future research employing more rigorous designs, such as adequately powered randomized controlled trials with appropriate controls.

This study found that PDAs alone are insufficient to reduce decisional conflict or improve negative attitudes toward cancer screening. Sole reliance on PDAs neither reduced decisional conflict (26) nor influenced negative attitudes toward cancer screening (54). While prior systematic reviews have highlighted the effectiveness of decision support tools in improving patient outcomes, they have also noted that their use does not guarantee the occurrence of SDM, as evidenced in this review (32). Similarly, another literature review suggested that PDAs can be difficult for patients to understand and access due to their limited availability, outdated information, and poor discoverability (62). In contrast, studies employing structured training formats—such as a psychosocial rehabilitation program with role-playing and simulation (49) or decision support and coaching based on the Three-Talk Model (55)—have demonstrated improvements across multiple patient outcomes, suggesting that SDM programs grounded in theoretical frameworks and incorporating essential interactive components can be effective. This is supported by findings that patient outcomes improved when PDAs were combined with education and consultation from healthcare professionals (47, 48). However, such comprehensive approaches remain limited in South Korea. Moreover, only three studies explicitly mentioned using the IPDAS criteria to evaluate their tools (26, 47, 54). Given the absence of IPDAS guidelines reflecting Korean culture and language, there is an urgent need to develop these guidelines and design a patient decision aid development process based on them. Therefore, future SDM interventions in South Korea should focus on integrating PDAs into more comprehensive, interactive programs that incorporate elements of education, counseling, and shared deliberation. Efforts should also be directed toward developing culturally and linguistically appropriate IPDAS guidelines.

Most studies have examined the variables that moderate the effects of SDM on patient outcomes. In the patient domain, factors such as income, educational level, illness stage, health literacy, and patient attitudes influenced outcomes (26, 28, 48, 50, 52–54). Previous reviews reported similar findings regarding the influence of age and educational level (63). Older patients have limited clinical knowledge and lower overall educational levels, which may explain their tendency to take a more passive role in decision-making compared to younger patients. A study conducted in Western countries found that older adults expressed a desire to share or make their own medical decisions (64).

Enhancing patients’ preferences (29, 47), self-efficacy (49), and health literacy (53) can strengthen their motivation to participate and increase satisfaction with care. These findings suggest that SDM is an effective mechanism for improving patient attitudes and fostering behavioral changes, ultimately leading to better patient outcomes.

Education and training for patients and healthcare professionals are essential for implementing SDM in healthcare settings. Although this study identified only a limited positive impact of education and training on SDM outcomes, previous reviews have shown that SDM training can improve clinicians’ attitudes and knowledge, enhance patient–doctor communication, and positively influence patients’ QoL and SDM skills (57, 65, 66).

The present review identified factors, including inpatient services and physician support, as critical considerations (50, 52, 53). Lower SDM effectiveness among outpatients may stem from the structural challenges in South Korea’s healthcare system. For effective SDM, sufficient consultation time is crucial; however, limitations in South Korea’s healthcare delivery system and low reimbursement rates result in severely restricted outpatient consultation times (30). Therefore, active physician support is vital for fostering a high-quality patient–physician relationship and significantly improving patient participation (63, 64).

Patient characteristics, prior experience, health literacy, preferences, and perceptions are significant factors in determining the successful implementation of SDM. SDM providers should carefully consider these factors when exchanging information and engaging in patient decision-making.

Although SDM conceptually integrates multiple components—including information provision, patient participation, communication, and deliberation—the relevance of each element may vary by clinical context, disease type, and healthcare delivery environment. In the South Korean healthcare system, with time-constrained outpatient consultations and limited reimbursement mechanisms, applying the full SDM model uniformly across all diseases and patient groups may be impractical.

Evidence from reviewed studies highlights that the effectiveness of SDM varies depending on the clinical context and the complexity of the decisions involved. In emotionally charged or preference-sensitive conditions such as oncology and dialysis, interventions that integrate communication, counseling, and deliberation are particularly critical to supporting patient engagement and value-based decision-making. By contrast, in lower-stakes decisions, providing structured information with minimal interaction may be sufficient.

Moreover, patient characteristics—such as age, health literacy, and prior experience with SDM—necessitate tailored communication approaches. For example, older adults and individuals with limited health literacy often benefit more from guided participation than from passive information delivery (64). Conversely, younger or more health-literate patients may respond better to tools that emphasize autonomy and provide accessible information (67).

These differentiated approaches suggest the need for a contextualized SDM framework in South Korea—one that identifies essential or optional SDM components based on the clinical setting, patient capacity, and decision complexity. Developing differentiated models based on clinical need and structural feasibility could enhance SDM implementation in the South Korean context while preserving its patient-centered benefits. This would also support national policy efforts to integrate SDM into routine care delivery without overburdening the system.

This review provides a comprehensive overview of shared decision-making (SDM) programs and their effectiveness in the South Korean healthcare environment, demonstrating the potential for SDM to be implemented across diverse clinical settings. While most studies suggest a positive association between SDM and improvements in patient knowledge, reduced decisional conflict, and increased satisfaction, these outcomes have not been consistently observed across all cases. Therefore, maximizing the benefits of SDM and tailoring implementation strategies to the unique South Korean healthcare landscape will require further research and concerted policy initiatives.

Specifically, future efforts must prioritize developing a South Korea-specific SDM model that reflects the characteristics of the Korean healthcare system—notably its brief consultation times, limited reimbursement for counseling, and persistent provider–patient information asymmetry—as well as its prevailing cultural values, rather than relying on uniform SDM models. This model should incorporate clinical area specialization, customizing SDM to address specific contexts such as chronic disease management, cancer treatment, and mental health services, while remaining sensitive to the needs of particular patient groups, including older adults and those with limited health literacy. For older adults, respecting family-centered decision-making processes is essential, and providing easy-to-understand language and visual aids is crucial for those with lower health literacy. Simultaneously, research should explore effective strategies for integrating these elements into existing healthcare workflows, potentially through pre-visit information preparation and the use of online decision support tools to facilitate more efficient consultations.

Alongside model development, the consistent and reliable measurement of SDM effectiveness will depend on the development and application of standardized evaluation tools. These tools should encompass measurement domains that capture a range of outcomes, incorporating patient knowledge, decisional conflict, satisfaction levels, quality of life, behavioral changes like treatment adherence, and objective health indicators. Cultural appropriateness must be ensured by either developing evaluation tools specifically for the Korean cultural context or rigorously adapting existing tools through careful translation and validation. These measurement efforts should be accompanied by rigorous study designs and concurrent qualitative research to definitively establish the effectiveness of SDM interventions. Future research should employ RCTs and quasi-experimental designs, complemented by qualitative approaches that allow for a nuanced understanding of patient and healthcare professional experiences, as well as the qualitative aspects of the SDM process.

Furthermore, policy support and incentives are essential for promoting and encouraging SDM implementation. Financial incentives could be considered to integrate SDM into value-based payment models or bundled payment agreements, as well as to provide direct reimbursement for the time invested in SDM activities.

In conclusion, successful SDM integration in Korea hinges on the systematic and pragmatic development of a comprehensive framework that incorporates key components, such as validated conversation models, a certification/accreditation system for decision support tools, and education and training programs, alongside a careful exploration of its suitability for specific clinical settings or patient populations in the Korean context.