title: Involving patients in decisions during psychiatric consultations.
abstract: BACKGROUND
  Patient involvement in the decision-making process is a key element for good clinical practice. Few data are available on patient involvement in psychiatry.
  
  
  OBJECTIVE
  To assess in a psychiatric out-patient context how psychiatrists involve patients in therapeutic decisions and to determine the extent to which patient and psychiatrist characteristics contribute to patient involvement.
  
  
  METHODS
  Eighty transcripts from audiotaped first out-patient consultations, conducted by 16 psychiatrists, were rated with the OPTION (observing patient involvement) scale. Interrater reliability indices were obtained for 30 randomly selected interviews. Associations between OPTION scores and some clinical and socio-demographic variables were tested using t-test, ANOVA and Pearson's correlation coefficient where appropriate. The distribution of scores for each psychiatrist was assessed by intracluster correlation coefficients.
  
  
  RESULTS
  Interrater reliability and internal consistency of the OPTION scale in the psychiatric setting were satisfactory. The total score and the ratings for the single OPTION items showed a skewed distribution, with a prevalence of scores in the low range of abilities, corresponding to minimal attempts to involve patients or a minimal skill level.
  
  
  CONCLUSIONS
  The OPTION scale proves to be a reliable instrument to assess patient involvement in a psychiatric setting. Psychiatrists showed poor patient involvement abilities parallel to previous findings in psychiatry and primary care. They need to be encouraged to share treatment decisions with their patients and to apply patient involvement skills. Further research is needed to establish which patient variables and clinical settings in psychiatry are more amenable to shared decisions, and how participation of psychiatric patients in treatment decisions will affect the outcome.
authors.affiliation: Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Policlinico G.B. Rossi Piazzale L.A. Scuro 10, 37134 Verona, Italy. claudia.goss@univr.it
authors.forename: Claudia
authors.initials: C
authors.lastname: Goss
authors.forename: Francesca
authors.initials: F
authors.lastname: Moretti
authors.forename: Maria Angela
authors.initials: MA
authors.lastname: Mazzi
authors.forename: Lidia
authors.initials: L
authors.lastname: Del Piccolo
authors.forename: Michela
authors.initials: M
authors.lastname: Rimondini
authors.forename: Christa
authors.initials: C
authors.lastname: Zimmermann
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D001291:Attitude of Health Personnel; D003142:Communication; D006801:Humans; D007558:Italy; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D010358:Patient Participation; D010817:Physician-Patient Relations; D011594:Psychometrics; D015203:Reproducibility of Results