Shared decision making: The reliability of the OPTION scale in Italy § Claudia Goss a, * , Silvia Fontanesi a , Maria Angela Mazzi a , Lidia Del Piccolo a , Michela Rimondini a , Glyn Elwyn b , Christa Zimmermann a a Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy b Centre for Health Sciences Research, Cardiff University, Cardiff, UK Received 8 November 2006; received in revised form 22 December 2006; accepted 3 January 2007 Abstract Objective: To provide psychometric characteristics of the Italian language version of the OPTION scale and descriptive statistics on patients’ involvement. The OPTION scale assesses the extent to which clinicians involve patients in therapeutic decisions. The English language version has a Cohen’s k score for individual items ranging from 0.45 to 0.98 and an intraclass correlation coefficient (ICC) for the total score of 0.77. Methods: Six male GPs provided 235 audiotaped consultations with consecutive patients who had attended for a new illness episode over a 2- month period. Thirty interviews were rated by two raters to assess inter- and intra rater as well as test–retest reliability of the Italian language version of the OPTION scale. Based on the whole sample, Cronbach’s a and an exploratory factor analysis were performed to assess internal validity and to determine factor loadings. Results: Cohen’s k values were comprised between 0.29 and 0.73, the ICC at test and retest was 0.85 and 0.81 and Cronbach’s a 0.82. The ratings for each OPTION item showed a skewed distribution: the majority of scores (>70%) were between 0 (behaviour absent) and 2 (minimum skill level). Conclusion: The reliability indices were satisfactory and similar to those reported for the original OPTION. Practice implications: OPTION can be used for both teaching purposes and research, as well as for future cross-national comparisons. # 2007 Elsevier Ireland Ltd. All rights reserved. Keywords: OPTION; Patient involvement; Shared decision making; Psychometric characteristics; Communication 1. Introduction The active collaboration between doctor and patient has been recently encouraged through the shared decision making model [1,2]. Several studies have been conducted to assess the importance of this approach [3,4] and to evaluate patient’s preferences [5]. It was shown also that clinicians can learn the skills, which promote greater patient involvement in health care decision making [6]. However, what really happens during consultations has not been definitely established. Some studies have analyzed the information giving process as the first step towards a shared decision. Lee and Garvin [7] commented that the information process is more an information transfer (based on a one-way monologue) than an information exchange (based on two-way dialogue). A recent study using the method of sequence analysis [8] has shown a low frequency of patient expressions of opinions and questions immedi- ately before and after General Practitioners’ (GPs) gave information, and a lack of facilitating questions by GPs, indicating a limited degree of patient involvement in the consultation [9]. The debate about how and when to encourage patients to participate in decisions about their care and about what are the most appropriate tools and outcome measures to evaluate the process is still open [10]. Instruments for measuring www.elsevier.com/locate/pateducou Patient Education and Counseling 66 (2007) 296–302 § I confirm all patient/personal identifiers have been removed or disguised so the patient/person(s) described are not identifiable and cannot be identi- fied through the details of the story. * Corresponding author at: Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy. Tel.: +39 045 8074441; fax: +39 045 585871. E-mail address: claudia.goss@univr.it (C. Goss). 0738-3991/$ – see front matter # 2007 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.pec.2007.01.002