title: Decision-making in multiple sclerosis consultations in Italy: third observer and patient assessments.
abstract: OBJECTIVE
  To assess decision-making in multiple sclerosis (MS) from third observer and patient perspectives.
  
  
  METHODS
  Audio recordings of first-ever consultations with a participating physician (88 outpatients, 10 physicians) at four tertiary MS care clinics in Italy, were rated by a third observer using the Observing Patient Involvement in Shared Decision Making (OPTION) and by patients using the Perceived Involvement in Care Scale (PICS).
  
  
  RESULTS
  Mean patient age was 37.5, 66% were women, 72% had MS, and 28% had possible MS or other disease. Mean PICS subscale scores (range 0 poor, 100 best possible) were 71.9 (SD 24.3) for "physician facilitation" (PICS-F); 74.6 (SD 22.9) for "patient information exchange" (PICS-I); and only 22.5 (SD 16.2) for "patient decision making" (PICS-DM). Mean OPTION total score (0 poor, 100 best possible) was 29.6 (SD 10.3). Poorest OPTION scores were found for items assessing "preferred patient approach to receiving information" and "preferred patient level of involvement." Highest scores were for "clinician drawing attention to identified problem", "indicating need for decision making," and "need to review the decision." Consultation time, woman physician, patient-physician gender concordance and PICS-F were associated with higher OPTION total score; older physician and second opinion consultation were associated with lower OPTION score.
  
  
  CONCLUSIONS
  In line with findings in other settings, our third observer findings indicated limited patient involvement abilities of MS physicians during first consultations. Patient perceptions of physician skills were better than third observers', although they correlated. Consultations with women physicians, and younger physicians, were associated with higher third observer and patient-based scores. Our findings reveal a need to empower Italian MS physicians with better communication and shared decision-making skills, and show in particular that attention to MS patient preferences for reception of information and involvement in health decisions, need to be improved.
authors.affiliation: Department of Neuroscience and Imaging, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.
authors.forename: Erika
authors.initials: E
authors.lastname: Pietrolongo
authors.forename: Andrea
authors.initials: A
authors.lastname: Giordano
authors.forename: Monica
authors.initials: M
authors.lastname: Kleinefeld
authors.forename: Paolo
authors.initials: P
authors.lastname: Confalonieri
authors.forename: Alessandra
authors.initials: A
authors.lastname: Lugaresi
authors.forename: Carla
authors.initials: C
authors.lastname: Tortorella
authors.forename: Maura
authors.initials: M
authors.lastname: Pugliatti
authors.forename: Davide
authors.initials: D
authors.lastname: Radice
authors.forename: Claudia
authors.initials: C
authors.lastname: Goss
authors.forename: Christoph
authors.initials: C
authors.lastname: Heesen
authors.forename: Alessandra
authors.initials: A
authors.lastname: Solari
mesh_terms: D000328:Adult; D003657:Decision Making / Q000502:physiology*; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000523:psychology*; D010358:Patient Participation; D010817:Physician-Patient Relations; D012017:Referral and Consultation
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