Current status and prospects of shared decision-making for severe knee osteoarthritis in Korea: a narrative review

Purpose: The treatment of severe knee osteoarthritis (KOA) represents a preference-sensitive decision in which the traditional informed consent model is insufficient, particularly within South Korea’s time-constrained clinical setting. This review examines the current status of shared decision-making (SDM) and proposes a strategic framework for a Korean-specific model to strengthen patient-centered care.Current Concepts: Globally, SDM has been incorporated into healthcare policy and is clinically demonstrated to enhance patient quality of life, satisfaction, and functional outcomes while reducing decision regret. Patient decision aids (PtDAs) are essential evidence-based tools for implementation. A key advancement is the Korean Shared Decision-Making Model for Severe KOA (K-SDM-KOA), which follows a 5-step process and incorporates a pre-consultation web-based PtDA designed to empower patients and optimize limited clinician–patient interaction.Discussion and Conclusion: Substantial barriers to SDM adoption in Korea remain, including the absence of reimbursement mechanisms, the persistence of a traditionally paternalistic medical culture, and limited clinician training. Addressing these obstacles requires a multi-pronged approach: clinically validating culturally adapted models such as the K-SDM-KOA, integrating SDM training into medical education, establishing reimbursement policies, and applying technologies such as artificial intelligence to create personalized PtDAs. Embedding SDM into clinical practice for severe KOA would mark a paradigm shift from information delivery to genuine partnership, ultimately improving health outcomes and achieving truly patient-centered care.