Efforts to link declarations to actions: Italian experiences of Shared Decision Making in clinical settings.

The Italian National Health Plan 2006-08 acknowledges the importance of patient/citizen participation, highlighting that health services have to involve patients by means of a shared decision-making (SDM) approach. The present study aims at examining the implementation of SDM in clinical settings in Italy, describing some experiences, practical difficulties and potential solutions. We found that the majority of patients want to participate in decision-making, but substantial knowledge gaps represent a barrier. Small proportions of patients express opinions and questions during the medical encounter, with a lack of facilitating questions by physicians, indicating a limited degree of involvement. The project Partecip a Salute is an initiative aiming at involving citizens, patient associations and scientific-medical professionals in the health and clinical research debate. The literature review on Italian SDM experiences has shown a limited number of publications, with the majority being commentaries or letters. In conclusion, in order to put SDM into practice more organizational and educational efforts are needed directed to both health professionals and patients/consumers. Documenting and sharing experiences is a fundamental prerequisite for progressing in the field.