Participation of patients and citizens in healthcare decisions in Italy.

WHAT ABOUT POLICY REGARDING SDM? The Italian National Health Plan and many regional and local health authorities explicitly recognise the importance of patient/citizen participation. These official documents rarely mention the specific concept of SDM, but they use terms such as patient involvement, participation, and empowerment. Patient associations are actively involved in promoting patient/citizen participation, but still play a marginal role in the health debate compared to health professionals, clinicians and healthcare managers. WHAT ABOUT TOOLS - DECISION SUPPORT FOR PATIENTS? There are only a few examples of decision aids designed for patients according to SDM concepts. A critical point is the lack of specific tools for the evaluation of SDM processes. Exceptions include the Italian versions of the OPTION scale and the SDM-Q, used at the micro-level for the evaluation of SDM. What about professional interest and real implementation? Health professionals recognise that doctor-patient communication is an important area. Italian research in SDM has grown and improved. It is very promising, but still limited. Undergraduate and postgraduate courses of some medical schools include specific programs on doctor-patient communication skills, focusing also on promotion of patient participation. WHAT DOES THE FUTURE LOOK LIKE? In conclusion, there is room for improving the Italian efforts to implement SDM into practice at both the individual and public level