Experiences, perceptions and preferences regarding medical decision-making in South Korea: a nationwide cross-sectional survey of the general public.

Abstract

Active patient involvement is a core principle of patient-centred care, yet public experiences of medical decision-making in non-Western settings remain underexamined. In South Korea, nationwide evidence on how adults experience, perceive and prefer medical decision-making is limited. This study, therefore, examined Korean adults' experiences, perceptions and preferences regarding medical decision-making. A cross-sectional study was conducted between March and April 2025 using online data collection for adults aged 19-59 years and face-to-face interviews for those aged 60 years or older. This nationwide survey was conducted in South Korea. A total of 1081 Korean adults were recruited using proportional quotas for sex, age group and region. After excluding withdrawals and invalid responses, 1000 were included (response rate 92.5%). Overall, 70.4% of respondents reported at least one significant health-related decision in the past 2 years. Although 34.1% reported making their most recent decision independently, a larger proportion preferred collaborative decision-making involving clinicians and/or family members. The clinician's explanation was the most influential factor (77.4%). Preferences for primary decision-maker varied by clinical context: patient-led decisions were favoured for low-risk interventions such as vaccination (78.5%), whereas physician involvement was preferred for life-threatening illness (86.2%). Communication ratings were highest for presentation of treatment options (mean score 3.56±0.79 on a 5-point scale) and lowest for explanation of potential treatment risks (mean score 3.20±0.89). Participants satisfied with decision outcomes reported higher communication quality (p<0.001), while those reporting neutral satisfaction (37.1%) resembled dissatisfied participants (4.1%). Medical decision-making was common, but respondents' experiences did not always match their preference for collaborative involvement. The findings suggest that strengthening patient-centred care in South Korea will require not only improvements in patient-clinician communication, but also attention to family involvement and structural conditions such as limited consultation time and current reimbursement arrangements.