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Patient experiences and ideas are key components for improving health promotion and prevention. Engaging patients and other stakeholders in sharing their practices and ideas is nowadays crucial to increase the legitimacy, credibility, and acceptability of the decisions in these fields, by fostering community wisdom. The World Café is a participatory method suitable to involve a large number of actors to propose creative solutions based on their different knowledge and experiences. However, the diffusion of this approach is not uniform in the various countries and health topics. This review summarises the specific topic, the study design, the number and the characteristics of participants, as well as the main findings and the purpose of the studies regarding the application of this method to health promotion and prevention. Among other results, it was found that the World Café is an appreciated, inspiring, and flexible participatory process often used in association with one or more other methods, to explore emergent themes or topics, to collect best practices or suggestions, to generate improvements or recommendations, and to define priorities for the implementation of projects or research agendas. The results highlight the potentiality of the World Café whenever an issue is not well defined and needs to be explored through deep and several insights. The method allows the exploitation of creativity and collective wisdom when qualitative and in-dept results-more than quantitative and statistically rigorous ones-are appropriate.

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BACKGROUND: Inappropriate ionising medical imaging has been escalating in the last decades. This trend leads to potential damage to health and has been associated to bioethical and legal issues of patient autonomy. METHODS: While the doctrine underlines the importance of using informed consent to improve patient autonomy and physician-patient communication, some researchers have argued that it often falls short of this aim. There are basically two different informed consent practices. The first - the so-called "event-based model" - regards informed consent as a passive signature of a standard unreadable template, performed only once in each medical pathway. The second - the so-called "process-based model" - integrates information into the continuing dialogue between physician and patient, vital for diagnosis and treatment. RESULTS: Current medical behaviour often embraces the event-based model, which is considered ineffective and contributes to inappropriateness. We sought, in this review, to analyse from juridical and communication standpoints whether process-based informed consent can deal with scientific uncertainties in radiological decision-making. The informed consent is still a distinctive process in defence of both patients' and physicians' health and dignity in rule-of-law states and consequently in curtailing the abuse of ionising medical radiation. MAIN MESSAGES: • Inappropriate ionising medical imaging is widespread and increasing worldwide. • This trend leads to noteworthy damage to health and is linked to the issue of patient autonomy. • Some authors have argued that informed consent often falls short of improving patient autonomy. • Process-based informed consent can deal with scientific uncertainties to contrast inappropriateness. • Informed consent is still a distinctive process in defence of both patients and physicians.

RESUMEN

The phenomenon of inappropriateness in ionizing imaging and medical interventions is large-scale and increasing. This tendency causes noteworthy damages to health and to patient's autonomy. Moreover, this trend causes a huge increment of health expenditures, waiting lists, organizational conflicts, judicial disputes, insurance compensations. The actual passive signature on unreadable templates of informed consent in the Italian hospital context constitutes, by a matter of facts, a central node of inappropriateness problem. This way to manage informed consent - "event" model - mortifies the patient's right to decide freely and deliberately, being him unaware of biological consequences of clinical-therapeutical interventions on himself and his progeny's health. Physician himself can generate arbitrary clinical acts, with heavy deontological and legal consequences. Hence, informed consent in ionizing imaging necessitates a particular "process" management, useful to convey a series of other clinical and organisational processes towards a full realisation of therapeutic alliance among physician and patient. This review aims at highlighting - in a juridical and communicative key - a range of tools which are applicable to contrasting the hospital abuse of ionizing radiations, for defending both patients' health and patients' dignity, being them primarily persons and citizens of a rule-of-law State.

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The clinical-legal assumption underlying the therapeutic alliance is to ensure the patient wellbeing by improving quality standards and appropriateness of healthcare services and procedures provided by hospital facilities. Therapeutic alliance, clinical decision-making and clinical and organizational appropriateness should translate legally into a common denominator, i.e. the informed consent. The legal implications of informed consent allow to distinguish clearly appropriate and legitimate healthcare provision from arbitrary therapeutic interventions. A patient informed consent requires adequate and timely information to be provided by the treating physician (or medical personnel), and represents the starting point from which to protect the right to health as well as the patient's right to decide about treatment. The informed consent process may and/or should also contribute to safeguard the physician's right to practice quite his profession.

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