Decision-making in multiple sclerosis consultations in Italy: third observer and patient assessments

TY - JOUR

T1 - Decision-making in multiple sclerosis consultations in Italy: third observer and patient assessments

AU - Pietrolongo, Erika

AU - Giordano, Andrea

AU - Kleinefeld, Monica

AU - Confalonieri, Paolo

AU - Lugaresi, Alessandra

AU - Tortorella, Carla

AU - Pugliatti, Maura

AU - Radice, Davide

AU - Goss, Claudia

AU - Heesen, Christoph

AU - Solari, Alessandra

AU - AutoMS-group

PY - 2013/1/1

Y1 - 2013/1/1

N2 - OBJECTIVE: To assess decision-making in multiple sclerosis (MS) from third observer and patient perspectives.METHOD: 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.

AB - OBJECTIVE: To assess decision-making in multiple sclerosis (MS) from third observer and patient perspectives.METHOD: 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.

KW - Adult

KW - Decision Making

KW - Female

KW - Humans

KW - Italy

KW - Male

KW - Middle Aged

KW - Multiple Sclerosis

KW - Patient Participation

KW - Physician-Patient Relations

KW - Referral and Consultation

U2 - 10.1371/journal.pone.0060721

DO - 10.1371/journal.pone.0060721

M3 - SCORING: Journal article

C2 - 23565270

VL - 8

SP - e60721

JO - PLOS ONE

JF - PLOS ONE

SN - 1932-6203

IS - 4

ER -