As the paradigm in healthcare nowadays is the evidence-based, patient-centered decision making, the issue of shared decision making (SDM) is highlighted. The aims of this manuscript were to look at the relevant concepts and suggest the facilitating strategies for overcoming barriers of conducting SDM. While the definitions of SDM were discordant, several concepts such as good communication, individual autonomy, patient participants, and patient-centered decision-making were involved. Further, the facilitating strategies of SDM were to educate and train physician, to apply clinical practice guidelines and patient decision aids, to develop valid measurement tools for evaluation of SDM processes, and to investigate the impact of SDM.
Summary
Korean summary
오늘날 보건의료가 지향하는 목표가 근거에 기반한 환자중심의 의사결정 (Evidence-based Patient-centered Decision Making)인 점에서, 공유된 의사결정 (Shared Decision Making, SDM)의 중요성이 강조되고 있다. 본 원고는 SDM의 관련 개념들을 정리하고, 진료에 적용하는 과정에서의 한계점들과 이를 극복하기 위한 방안들을 살펴보았다.
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Korean summary
지역사회건강조사는 보건소별로 층화집락추출법으로 900명을 조사하여 보건소단위의 건강지표를 생산하고 있다. 동읍면단위 건강지표의 생산을 요구하는 보건소가 증가하고 있으나 일부 동읍면은 조사된 인원이 십여명 정도이므로 통상적 통계기법으로는 일정 수준의 정도를 갖는 동읍면단위 건강지표를 생산할 수 없다. 본고에서는 외부행정정보 또는 인접 동읍면을 통합한 자료를 이용하는 추정방법인 소지역추정법을 이용하여 동읍면단위 흡연율을 생산하는 알고리즘을 소개하고 2013년 강남구 보건소자료를 사용한 수치적인 결과를 예시하였다.
Korean summary
퍼지셋 질적비교연구(Fs/QCA)는 사회과학 방법론에서 사례중심의 질적분석과 변수중심의 양적분석을 통합하기 위해 개발된 시도로 주요 특징으로는 양적 분석과 비교할 때, 결합된 요인들의 인과관계가 내포하는 인과적 복합성을 살펴보기 위하여 연구자에게 더 많은 자유도를 허용한다는 것이다. 또한 퍼지셋 질적비교연구는 사례중심 연구가 이론화 및 과학적 측정에 있어 갖게 되는 한계를 인식하여, 경험적 증거를 통한 과학성의 확보를 위해 집합소속 정도에 대한 눈금매기기를 실시한다. 그러면서도 동시에 변수중심의 연구가 갖는 한계로 지적되는 방법론과 이론과의 연결성을 높이기 위해 집합 이론적 접근을 시도한다. 즉, 눈금매기기를 통해 변수중심 연구의 속성을 가지면서도 집합 이론을 활용하여 사례중심 연구의 속성도 내포하고 있다고 볼 수 있는 것이다.
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Korean summary
면역반응에서 핵심적인 역할을 하는 T 세포의 노화는 CD28의 소실 및 CD57의 발현으로 특징지어진다. 최근, 고혈압을 비롯한 각종 심혈관질환에서 이러한 노화 T 세포가 증가해 있음이 보고되고 있다. 향후, 노화 T 세포와 심혈관질환의 연관성 및 그 기전에 대한 심도 깊은 연구가 필요하다.
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