Shared decision making: the reliability of the OPTION scale in Italy.

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 kappa 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 alpha and an exploratory factor analysis were performed to assess internal validity and to determine factor loadings. RESULTS: Cohen's kappa values were comprised between 0.29 and 0.73, the ICC at test and retest was 0.85 and 0.81 and Cronbach's alpha 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.

[How to involve patients in the decision making process]. / Come coinvolgere il paziente nelle decisioni che riguardano la salute. Strategie comunicative.

In the last recent years the need to improve the doctor-patient communication rose the question on how to involve patients in the decision making process. Aim of this paper is to propose some practical abilities that can be used to improve patient involvement in the decision making process.

Evaluation of the molecular mechanisms involved in the gain of function of a Li-Fraumeni TP53 mutation.

The TP53 tumor suppressor gene is the most frequent target for genetic alterations in human cancer. TP53 gene alterations may result in the gain of oncogenic functions such as neoangiogenesis and resistance to therapy. The TP53 germ line mutation c.659A>C (p.Y220S) was identified in stored DNA from related patients with Li-Fraumeni syndrome (LFS) who died after developing clinically aggressive tumors. All of the patients were treated with protocols that included doxorubicin hydrochloride (DX) as a pivotal drug. To define the in vitro mutational phenotype of this germ line mutation, we used murine fibroblasts explanted from wild-type (wt) and p53 knockout (KO) mice from the same littermate. p53Y220S and p53R175H fibroblasts, obtained from p53KO fibroblasts transfected with expression vectors encoding the human Y220S and R175H p53 mutants, respectively, exhibited resistance to DX treatment. Moreover, p53Y220S fibroblasts exhibited angiogenetic properties, and after DX treatment, p53Y220S failed to translocate into the nucleus and showed an increase in its cytosolic levels. DX treatment does not influence p53 distribution within the nuclear and cytosolic compartments in p53R175H fibroblasts. Peroxiredoxin II (Prx II), a protein that is involved in eliminating reactive oxygen species (ROS), showed increased expression intensity in p53Y220S fibroblasts after DX treatment, as observed by two-dimensional electrophoresis analysis. Moreover, Thioredoxin (Trx), a protein that cooperates with Prx II, is overexpressed in p53Y220S mutants under basal conditions. These data suggest a relationship between the presence of the p53Y220S mutation and enhanced levels of Prx II and Trx in mutant fibroblasts. Since one of the mechanisms of the DX antitumor effect has been ascribed to production of ROS, future studies will evaluate the involvement of PrxII and Trx in the chemoresistance of p53Y220S fibroblasts to DX.

[The assessment of patient involvement across consultation. The Italian version of the OPTION scale]. / Valutare il grado di coinvolgimento del paziente durante una visita: la versione italiana dello strumento OPTION.

AIM: To present the Italian version of the OPTION (observing patient involvement) rating scale, developed in UK by Elwyn et al. (2005), and its psychometric characteristics, together with some findings when applied on the consultations transcripts of a group of Italian General Practitioners. METHODS: The OPTION scale assesses the extent to which clinicians involve patients in decisions and consists of 12 items to be rated on a 5 point scale (from 0--behaviour not observed to 4--high standard). The scale was applied to 235 transcripts of audiotaped consultations conducted by 6 male GPs. Interrater and test-retest reliability and internal validity indices were calculated on a subsample of 30 transcripts. RESULTS: The Italian language version of OPTION showed good psychometric properties, similar to those reported for the original version. The ratings obtained for 235 consultations showed for each OPTION item a skewed distribution: the majority of scores (> 70%) were between 0 (behaviour absent) and 2 (minimum skill level). CONCLUSIONS: The Italian language version of OPTION seems a reliable instrument to assess patient involvement in primary care settings also in Italy. The clustering of low scores confirms previous findings that clinicians without a specific training obtain very low levels of patient involvement in the decision making process.

A mutated p53 status did not prevent the induction of apoptosis by sulforaphane, a promising anti-cancer drug.

We investigated apoptosis induction by sulforaphane on three cell lines characterized by a different p53 status. In particular, we used p53-knock-out fibroblasts from newborn mice transfected with the p53-Ser220 mutation, observed in Li-Fraumeni Syndrome patients, as a model of mutated p53 status. Moreover, immortalized fibroblasts from newborn mice expressing or lacking p53 (p53 +/+ and p53-/-, respectively) have been used to verify whether mutated p53 status could prevent sulforaphane-induced apoptotic events. Sulforaphane was able to induce apoptosis on all three cell lines. Indeed, the caspase-3 assays and poly(ADP-ribose)polymerase (PARP) cleavage data indicated that sulforaphane stimulated caspase-3-like activity and degradation of PARP. However, cells with a wild-type or mutated p53 appeared to be more sensitive to the effects of sulforaphane than cells lacking p53. Taken together, our results suggest that sulforaphane could act by a p53-independent pathway. For this reason, sulforaphane can be viewed as a novel agent useful not only in the treatment of Li-Fraumeni-associated tumors but also drug resistant tumors where p53 dysregulation is a feature.