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

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 fourtertiary MS care clinics in Italy, were rated by a third observer using the Observing Patient Involvement in Shared DecisionMaking (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 PICSsubscale 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 totalscore (0 poor, 100 best possible) was 29.6 (SD 10.3). Poorest OPTION scores were found for items assessing ‘‘preferredpatient approach to receiving information’’ and ‘‘preferred patient level of involvement.’’ Highest scores were for ‘‘cliniciandrawing 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 higherOPTION 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 involvementabilities 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 thirdobserver and patient-based scores. Our findings reveal a need to empower Italian MS physicians with better communicationand shared decision-making skills, and show in particular that attention to MS patient preferences for reception ofinformation and involvement in health decisions, need to be improved