Purpose: This study was designed to identify the impediment factors for end-stage medical decisionmaking as perceived by nurses and physicians in Korea. Method: The subjects in this descriptive exploratory study were 82 nurses and 61 physicians working in university hospitals in the Korean cities of Daegu and Busan. Principal component analysis was implemented in the exploratory factor analysis study, where the eigen value 1 was used for the basis of factor extractor and Varimax rotation was used to divide the factors. The data were analyzed by a SPSS/WIN 15.0 program. Result: The analysis of the impediment factors for end-stage medical decision-making revealed 15 statements and 5 categorized factors: legal compliance, prescriptive health professionals, interpersonal preparation, hospital systems, and ethical belief. These factors explained 66.84% of the total variance. Legal compliance was requested excessive roles and responsibilities of healthcare providers. Prescriptive health professionals were indicated reflection of paternalistic decision making type. Interpersonal preparation was claimed for readiness toward appropriate medical decision making issues among patient,families and healthcare providers. Hospital systems were showed inappropriate management of hospice palliative wards. Ethical belief was determined as an impediment factors for end stage medical decision making. Conclusion: We divided impediment factors for appropriate end stage medical decision-making into 5 separate categories. There is a need for a formation of a decision making system that includes the patient - health professional - family which is based on promoting the free choice of the patient while providing an atmosphere of open communication between health professionals which will facilitate the decision making process. The results of this study may contribute to the development of a new endstage decision-making system that is appropriate for medical care in Korea.

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Purpose: The purposes of this study were to identify future changes that may affect medical decision-making and to suggest future directions for the medical decision-making system in Korea. Methods: This study conducted Delphi surveys and in-depth group interviews with physicians and nurses working in two different university hospitals in Daegu and Busan. Results: The collected data suggest that the current medical decision-making system needs to be more clearly defined in accordance with clinical applications. The findings from professional group interviews suggest that the Korean government may need to regulate economic conditions in order to facilitate medical decision-making in the near future as hospital environments change and grow. Conclusion: The results of this study may help healthcare professionals working at various crisis settings to understand and apply decision-making systems in the context of end-of-life medical care. The future directions were proposed that national standard setting and financial support, hospital ethics committee constitution, nationwide information for social consensus, strengthening the education of health professionals.

The study was conducted to develop and test a hypothetical model which explains Korean shared medical decision-making was established based on the King's theory. The participants were 580 adults who lived in one of 3 Korean metropolitan cities: Seoul, Daegu, and Busan. The data were collected using questionnaires from August 10 through October 25, 2011. The descriptive and correlation statistics were analyzed using the SPSS/WIN 15.0 and the structural equation modeling procedure was performed using the Amos 20.0 program. The results of this study showed that the attitude of dignified death were the strong factors influencing shared decision making in this sample. The attitude of withdrawal of life sustaining treatment didn't influenced to the shared decision making but the attitude of withdrawal of life sustaining treatment and the attitude of dignified death showed correlation between two factors. The proposed model was concise and extensive in predicting shared decision making of the participants. Findings may provide useful assistance in developing effective medical and nursing interventions for maintaining and promoting shared decision making in clinical situations.

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