Decision-Making in Multiple Sclerosis Consultations in Italy

Third Observer and Patient Assessments

Erika Pietrolongo, Andrea Giordano, Monica Kleinefeld, Paolo Confalonieri, Alessandra Lugaresi, Carla Tortorella, Maura Pugliatti, Davide Radice, Claudia Goss, Christoph Heesen, Alessandra Solari

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

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.

Original languageEnglish
Article numbere60721
JournalPLoS One
Volume8
Issue number4
DOIs
Publication statusPublished - Apr 2 2013

Fingerprint

sclerosis
Italy
Multiple Sclerosis
decision making
Decision Making
Referral and Consultation
physicians
Decision making
Physicians
Women Physicians
Audio recordings
Patient Participation
Health
Aptitude
Patient Preference
Communication
information exchange
Outpatients
communication (human)

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Decision-Making in Multiple Sclerosis Consultations in Italy : Third Observer and Patient Assessments. / Pietrolongo, Erika; Giordano, Andrea; Kleinefeld, Monica; Confalonieri, Paolo; Lugaresi, Alessandra; Tortorella, Carla; Pugliatti, Maura; Radice, Davide; Goss, Claudia; Heesen, Christoph; Solari, Alessandra.

In: PLoS One, Vol. 8, No. 4, e60721, 02.04.2013.

Research output: Contribution to journalArticle

Pietrolongo, E, Giordano, A, Kleinefeld, M, Confalonieri, P, Lugaresi, A, Tortorella, C, Pugliatti, M, Radice, D, Goss, C, Heesen, C & Solari, A 2013, 'Decision-Making in Multiple Sclerosis Consultations in Italy: Third Observer and Patient Assessments', PLoS One, vol. 8, no. 4, e60721. https://doi.org/10.1371/journal.pone.0060721
Pietrolongo, Erika ; Giordano, Andrea ; Kleinefeld, Monica ; Confalonieri, Paolo ; Lugaresi, Alessandra ; Tortorella, Carla ; Pugliatti, Maura ; Radice, Davide ; Goss, Claudia ; Heesen, Christoph ; Solari, Alessandra. / Decision-Making in Multiple Sclerosis Consultations in Italy : Third Observer and Patient Assessments. In: PLoS One. 2013 ; Vol. 8, No. 4.
@article{aa99defeda1d4f928f7752971c2468ff,
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. 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.",
author = "Erika Pietrolongo and Andrea Giordano and Monica Kleinefeld and Paolo Confalonieri and Alessandra Lugaresi and Carla Tortorella and Maura Pugliatti and Davide Radice and Claudia Goss and Christoph Heesen and Alessandra Solari",
year = "2013",
month = "4",
day = "2",
doi = "10.1371/journal.pone.0060721",
language = "English",
volume = "8",
journal = "PLoS One",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "4",

}

TY - JOUR

T1 - Decision-Making in Multiple Sclerosis Consultations in Italy

T2 - 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

PY - 2013/4/2

Y1 - 2013/4/2

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.

UR - http://www.scopus.com/inward/record.url?scp=84875681158&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84875681158&partnerID=8YFLogxK

U2 - 10.1371/journal.pone.0060721

DO - 10.1371/journal.pone.0060721

M3 - Article

VL - 8

JO - PLoS One

JF - PLoS One

SN - 1932-6203

IS - 4

M1 - e60721

ER -