{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T03:42:03Z","timestamp":1773373323771,"version":"3.50.1"},"reference-count":43,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T00:00:00Z","timestamp":1773273600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007366","name":"Fondazione Italiana Sclerosi Multipla","doi-asserted-by":"publisher","award":["2020\/R-Multi\/024"],"award-info":[{"award-number":["2020\/R-Multi\/024"]}],"id":[{"id":"10.13039\/100007366","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003196","name":"Ministero della Salute","doi-asserted-by":"publisher","award":["RRC"],"award-info":[{"award-number":["RRC"]}],"id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The ConCure-SM intervention [ISRCTN48527663] consists of an advance care planning (ACP) training program for neurologists\/other professionals caring for people with progressive multiple sclerosis (PwPMS). We assessed the communication competences of ACP-trained neurologists who participated in the trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Eighteen ACP conversations were audio-recorded. After each conversation, participants (PwPMS, significant others [SOs], and neurologists) rated the neurologist\u2019s communication skills using dedicated versions of the Quality of Communication questionnaire (QOC). Independent observers assessed the conversations using the Observing Patient Involvement in Shared Decision Making (SDM; OPTION), and the Verona Coding Definitions of Emotional Sequences (VR-CoDES).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Mean duration of the ACP conversations was 62.7 minutes. Neurologists (5\/7 women) were 30\u201362-year-old. PwPMS mean age was 61.8 years, 39% were women. Mean QOC scores (distinguished in general communication and end-of-life communication; 0\u2013100 scale) were 92.4, 90.1 respectively, according to PwPMS; 95.2, 94.3 according to SOs. Mean neurologists\u2019 self-reported QOC score (0\u2013100 scale) was 69.5. Mean OPTION score (0\u2013100 scale) was 48.4. PwPMS expressed a median of 8.5 cues (hints to emotion) and 3.0 concerns (explicit expressions of emotion) per conversation. Neurologists provided space to 59% of cues and 73% of concerns. A quarter of cues\/concerns contained figurative expressions or metaphors to express concerns or as signals of emotional distress. Moreover, 12% of expressions were coded as positive emotional statements (i.e., expressions indicating hope, confidence, and positive wishes).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Neurologists\u2019 communication skills during ACP conversations were rated as high using the QOC by both PwPMS and SOs, while neurologists rated their own skills more critically. Neurologists\u2019 SDM competences were moderate, but higher compared to two published studies on MS consultations. Qualitative and quantitative analysis of ACP conversation transcripts indicate that ACP can evoke many emotions. In most instances neurologists provided space for the PwPMS to elaborate on affective expressions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec005\">\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>ISRCTN48527663.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0336183","type":"journal-article","created":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T17:30:32Z","timestamp":1773336632000},"page":"e0336183","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Communication competences of multiple sclerosis neurologists during advance care planning conversations: A multi-observer study"],"prefix":"10.1371","volume":"21","author":[{"given":"Andrea","family":"Giordano","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5509-7626","authenticated-orcid":true,"given":"Ludovica","family":"De Panfilis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8012-2451","authenticated-orcid":true,"given":"Roberta Martina","family":"Zagarella","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulia","family":"Di Domenico","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0670-452X","authenticated-orcid":true,"given":"Mariangela","family":"Farinotti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto","family":"Gajofatto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Grazia","family":"Grasso","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2902-5589","authenticated-orcid":true,"given":"Alessandra","family":"Lugaresi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Montepietra","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Patti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudio","family":"Solaro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Riccardo","family":"Orlandi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giorgia","family":"Presicce","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simona","family":"Toscano","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simone","family":"Veronese","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1735-9362","authenticated-orcid":true,"given":"Lidia","family":"Del Piccolo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9930-7579","authenticated-orcid":true,"given":"Alessandra","family":"Solari","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"on behalf of the ConCure-SM project","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,3,12]]},"reference":[{"issue":"10","key":"pone.0336183.ref001","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1038\/s41582-024-01006-1","article-title":"Assessing disease progression and treatment response in progressive multiple sclerosis","volume":"20","author":"G Comi","year":"2024","journal-title":"Nat Rev Neurol"},{"issue":"9","key":"pone.0336183.ref002","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1056\/NEJMp1109283","article-title":"Shared decision 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