혈액투석 환자의 자가관리 향상을 위한 공유의사결정 항목 탐색: 델파이 기법

Exploring Shared Decision-Making Items to Enhance Self-Management in Hemodialysis Patients: A Delphi Study

Purpose : This study aimed to develop a hierarchical framework comprising major domains, subdomains, and items of self-management for shared decision-making in patients undergoing hemodialysis using a Delphi process. Methods : A three-round Delphi study was conducted with 15 experts, including nurses, nursing professors, and nephrologists. shared decision-making related self-management domains and items and their hierarchical relationships were identified through open-ended questions and a literature review in the first round. In the second and third rounds, experts rated their importance, and agreement was assessed. All items were evaluated using the Content Validity Ratio (CVR), with a minimum threshold of .49; convergence ≤0.50, consensus ≥.75, and coefficient of variation ＜.50. Results : The final framework comprised seven major domains, 14 subdomains, and 44 self-management items for SDM in hemodialysis care, excluding one item that did not meet the predefined CVR threshold. All retained items met the minimum CVR threshold and demonstrated acceptable levels of convergence (0.00∼0.50) and consensus (.75∼1.00). Among the major domains, ‘adaptive living management’ (4.93±0.26) scored the highest, followed by ‘engagement in treatment’ (4.87±0.35), with both ‘clinical management’ and ‘health management’ scoring 4.73 ±0.46. Conclusion : This study provides a structured hierarchical framework of major domains, subdomains, and items of self-management for SDM in hemodialysis care. The findings extend the applicability of shared decision-making beyond treatment options to recurring aspects of daily self-management. Further research is needed to validate this framework with patient involvement and to evaluate the effectiveness of interventions implementing these domains and items in clinical practice.