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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.

Nowadays, patient-centred practice represents the key for quality and successful outcomes in healthcare. At the same time, shared decision-making is acknowledged as the highlight of patient-centred care. Informed consent, whenever derives appropriately from a two-way communication between doctor and patient, follows a negotiation process that leads to appropriate and shared decisions. This article aims to show how the typical negotiating styles can lead or not to effective informed consent and conflict mediation processes. To this end, the three negotiating styles currently theorized (sharks, saints, and samurai) are integrated into the three clinical models of doctor-patient interaction (paternalistic, interpretative and autonomist). Currently, being any paternalistic attitude disapproved both ethically and legally, the model of autonomy is the only suitable one to communicate effectively. A concrete case from cardiology is reported to show the different negotiation styles within a doctor-patient conversation. Upstream, drawing inspiration from the samurai negotiating style, the doctor could find a new approach to effective informed consent. Downstream, during mediation, he/she could recompose all those conflicts that stem from an unsatisfying relationship with the patient. These results suggest, finally, that the physicians should be aware of their own prevalent negotiating style and of how to improve it if necessary.

[Transformative mediation in the era of the patient revolution. A model for the management of clinical and legal risk in Italian health facilities]Nowadays, too many patients do not perceive that their doctors are exclusively dedicated to care them. This is probably because current health systems are too focused on physicians and diseases, rather than on patients. Such systems are also expensive, fragmented, inefficient and often cynical, generating not only the anger but also the willingness to bring legal claims from many patients. Many scholars, in fact, claim that "too much medicine" can bring more harm than good to the patients and to the health systems themselves, therefore promoting a more sober and respectful medicine. This is the vision of the "patient revolution" and the idea that inspires some other movements that aim to break the vicious circle of greed and cynicism that damages not only patients but also health professionals. Within the same vicious circle, an exponential increase in litigations takes place, as an additional negative effect of the system focused on the disease and on the doctors instead of on the patient.In the present article, we assume that a greater participation of the patient in the choices concerning his/her own health is the fertile ground in which concrete solutions can be found to many problems arising from the current medicine. We therefore analyze the main advantages of active patient participation, which in turn generate a reduction in health conflicts. Based on this analysis, we propose a model in which through various approaches, tools and methods - starting from the upstream prevention of the conflicts - we can also manage them downstream, for the benefit of both patients and health professionals. Finally, we show that within this framework, transformative mediation is an essential approach for weakening many legal disputes and repairing the relational damage generated upstream, where communication has failed or is completely lacking in the clinical practice.

[The bi-directionality among informed consent process and mediation applied to healthcare conflicts] Informed consent in the hospital as in any other healthcare setting is - before anything else - a process of communication and relationship which must involve the patient in a decision directly affecting his/her health. In this article, we focus our attention on the bi-directionality existing among an informed consent process and the instrument of alternative dispute resolution constituted by mediation applied to healthcare conflicts. The link between the two legal institutions is bidirectional because informed consent is a fundamental premise of a good mediation and mediation - in turn - can be an important stimulus to continuously improve the process of informed consent. This bi-directionality for both legal institutions is fueled by the element of "trust". While trust in informed consent is the result of a continuous dialogue and listening between the doctor, the staff and the patient, in mediation it represents the crucial element to be redialed. Therefore, mediation in health care is an effective tool for managing conflicts to the extent that goes to latch on to a real and previous communicative relationship that actually materialized between the parties around the relationship of care. The emotional reality of the patient and his family - as well as that one regarding health professionals themselves - can emerge in an effective way during mediation, through the co-presence of the parties in a facilitated dialogue. This same reality can motivate health professionals to acquire a thorough and in-depth training on the aspects of values, techniques and tools necessary for the realization of a genuine process-based informed consent within an effective doctor-patient communication. All this can and must be done - in an organization sensitive to these issues - according to a virtuous cycle that feeds on itself and creates a renewed wellness for physicians as well as for patients in their inseparable relationship of care.

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. 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. 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. • 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.

[ Mediation in health care. Inappropriate use of ionizing tests, informed consent and opportunity of Legislative Decree n. 28/2010] Inappropriate use of ionizing tests in medicine represents an increasing trend, which causes noteworthy damages to health, as well as a huge increment of health expenditures, waiting lists, organizational conflicts, judicial disputes, and insurance compensations. This phenomenon is strictly related to the key bioethical and legal issue of patient’s autonomy, which is protectable by means of a correct implementation of informed consent. The current practice of the passive signature on incomplete and unreadable informed consent templates belongs to the so-called “event-based” approach. This practice mortifies the patient’s right to decide freely and deliberately, being him unaware of the biological consequences of diagnostic-therapeutic interventions on himself and on his progeny’s health. On the other hand, physicians themselves are not protected, since they can generate arbitrary clinical acts more frequently, with heavy deontological and legal consequences. Conversely, a “process-based” approach is necessary, which conveys informed consent in a series of other clinical and organisational processes towards a full therapeutic alliance among physician and patient. Actually, in both the presence and absence of the inauspicious event recurring also in the area of imaging as well as in other specialist areas, an arbitrary informed consent is the cause of deep conflicts, especially at relational level, between physician and patient. The authors suggest – in both juridical and communication perspectives – that these conflicts deserve to be properly analyzed and brought to the surface by the parties through the tool of mediation in healthcare, provided by Legislative Decree n. 28/2010. This tool is oriented not so much towards a technical solution at all costs, as towards a reconstruction of the care relationship, which unfortunately is lacking in the current way of conceiving and managing informed consent.

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.

We thank Prof. Vock for his noteworthy and constructive commentary [1]. This gives us the opportunity to briefly provide additional observations to elaborate this topic further. We agree with Prof. Vock that our theoretical approach [2] may not be applied in a non-invasive and low-dose medical imaging. Nevertheless, this makes the innovation that we are trying to develop even more challenging. We are all discussing about something similar to a “paradigm shift”, in the sense described by Kuhn [3]: (a) presenting results “sufficiently unprecedented to attract an enduring group of adherents away from competing modes of scientific activity” and (b) “being sufficiently open-ended to leave all sorts of problems for the redefined group of practitioners to solve.”