Patient Involvement as Understood by Healthcare Professionals: A Multi‐Methods Study in a Danish University Hospital

ABSTRACT

Aim

Although patient involvement is widely promoted in healthcare policy, there is limited understanding of how healthcare professionals interpret and implement it in practice. This study explores healthcare professionals' perceptions of patient involvement and how their understanding influences interactions with patients, addressing a gap in knowledge about its enactment in clinical practice.

Design and Methods

A multi‐methods design was used to capture both the breadth and depth of healthcare professionals' experiences. Quantitative survey data (n = 1214) were collected from multiple hospital departments and analysed descriptively. Semi‐structured interviews (n = 12) were conducted between April and November 2022 and analysed using hermeneutic content analysis. The survey assessed healthcare professionals' perceptions of patient involvement, while interviews explored how these perceptions were enacted in everyday practice.

Ethics Statement

According to The Danish Healthcare Act §42, studies of this type do not require formal ethical approval. All participants provided informed consent, and data were anonymized and securely stored.

Results

Survey findings indicated that 69% emphasized patients' role in influencing care decisions, 60% highlighted addressing patients' needs and preferences, and 37% noted patient education. Interviews revealed four central themes: patient involvement as shared decision‐making, fostering partnerships, integrating patients' lifeworlds into care, and recognizing the influence of healthcare professionals in guiding decisions. These illustrate how patient involvement is enacted through tailored communication and ethical management of professional influence.

Study Limitations

Although the qualitative interviews were limited by a small sample, they offered rich insights into professionals' interactions with patients, whereas survey responses reflected self‐reported perspectives and may be subject to selection bias.

Conclusions

Patient involvement is shaped by both professional actions and interaction dynamics. Healthcare professionals foster meaningful engagement through communication, shared decision‐making, ethical management of power asymmetries, and individualized support tailored to patients' circumstances and needs. The findings highlight the need for training, organizational strategies, and further research incorporating patient perspectives.

1. Introduction

Patient involvement has become an increasingly central focus in contemporary healthcare, yet the concept remains difficult to define and challenging to implement in practice. The definition of patient involvement, and the patient's role in the healthcare system, has varied over time. Interest in the concept has increased markedly since the 1990s. Worldwide, research has been conducted with many perspectives on understanding patient involvement [1, 2]. Despite this growing attention, patient involvement remains a complex and multifaceted concept that lacks a universally accepted definition, contributing to the ongoing debate in healthcare [3]. At the same time, evidence highlights the potential benefits of patient involvement for patients' experiences and clinical outcomes [4, 5], underscoring the need for conceptual clarity.

Some descriptions concentrate on the communication between healthcare professionals and patients, where the focus is on ensuring patients receive information so they are prepared for their experiences of healthcare and empowered: “The patient obtains sufficient, appropriate, understandable and meaningful information and knowledge to feel confident” [1, p. 6]. Others focus on the need to ensure healthcare professionals gain information to ensure care is tailored to patient needs and preferences, and to inform clinical decisions: “Providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions” [2, p. 31]. This definition also implies involvement is about enabling a collaboration between healthcare professionals and patients [2]. While previous research has examined leadership perspectives and the implementation of patient involvement interventions [3], less is known about how frontline healthcare professionals themselves understand the concept. Exploring how they make sense of and enact patient involvement in everyday practice is crucial, as their interpretations directly shape care delivery. This is particularly relevant because patient involvement has been associated with improved safety and quality of care [5].

Given these conceptual variations, the Danish User‐Involving Hospital project offers an opportunity to examine how patient involvement is understood in practice. Since 2014, this project at Aarhus University Hospital (AUH) has developed, implemented, and evaluated patient involvement interventions [6]. The project was initiated to increase the involvement of patients by using various patient involvement interventions such as shared decision‐making and self‐management support. A number of research projects have investigated the process of implementing patient involvement interventions in the clinical context at AUH. Among these, a study which investigated leadership expectations concerning the implementation of patient involvement in a hospital setting showed an overall common assumption that culture change is decisive for success [7]. Healthcare professionals are considered to be the essential actors in the process of culture change, which is why changing their habits and behaviour in terms of how they interact with patients is necessary [3, 7]. From the healthcare professionals' perspective, the factors for successful development and implementation of patient involvement interventions were related to top‐down and bottom‐up approaches [8]. Motivation, focus on information, and ensuring the right competencies during the process were important factors for the healthcare professionals [8]. Similarly, the healthcare professionals found it helpful to be given the opportunity to listen to the patients' perspectives [8]. A more recent study from 2024 investigated the current use of patient involvement interventions at AUH. It showed that the healthcare professionals were motivated to use the interventions because they were seen as beneficial for the patients' experiences [9].

Ten years after the User‐Involving Hospital project was initiated, as patient‐centred care continues to evolve, this study examines how healthcare professionals understand the concept of patient involvement and the impact their understanding has on interactions with patients in the specific context of their everyday practice in a user‐involvement hospital. The research questions addressed are:

1. How do healthcare professionals at AUH perceive the concept of patient involvement?

2. How does their understanding influence their interaction with patients?

2. Design

This study is a secondary analysis of data collected for another study published in 2024 [9]. It uses a multi‐methods design, incorporating both quantitative survey data and qualitative interview data, which allows for a comprehensive understanding of patient involvement by capturing both broad trends and the nuanced, in‐depth experiences of healthcare professionals. The overall focus of the original study was healthcare professionals' use of patient involvement interventions everyday practice and their perceived impact on care delivery. However, the comprehensive data contained rich descriptions of healthcare professionals' experiences of the concept of patient involvement, which were not analysed in depth in the previous publication. This secondary analysis is justified, as it uses the same dataset to address new research questions that were not explored in the original study. The consolidated criteria for reporting qualitative studies (COREQ) checklist were used for reporting in the study [10].

3. Participants and Setting

The study was conducted at AUH, a large university hospital with all medical and surgical specialties represented. AUH employs approximately 8500 healthcare professionals, including medical doctors, nurses, healthcare assistants, and allied health professionals (midwives, physiotherapists, occupational therapists, dietitians, radiographers, etc.), with all levels of experience. All qualified healthcare professionals from any hospital department with direct patient contact during daily care and treatment were eligible to participate in the survey study and interviews. The survey used a volunteer‐based sampling approach, and all eligible healthcare professionals were invited via the hospital's internal email system. Interview participants also received the invitation to complete the survey; however, due to the anonymous nature of the survey, it is not possible to determine whether they responded. The inclusion criteria for the interviews were a minimum of two years of practice and direct patient contact. To gather a broad variety of descriptions in the interviews, the purposeful sampling strategy was based on variation in age, gender, years of experience, and specialty. A convenience sampling strategy was used for the interviews, and within this group, purposeful selection ensured variation in age, gender, years of experience, and specialty. Students and trainees were excluded from the study.

4. Data Collection

All interviews were conducted using semi‐structured interviews [11] between April and June 2022. The interviews were guided by a semi‐structured interview guide [11], which was developed by the last author specifically for this study based on the literature on patient involvement. The guide was piloted with a small group of healthcare professionals, but no changes were required. The first part of the interview guide was designed to explore the participants' experiences of patient involvement in a clinical context. The questions were mainly formulated as open‐ended questions such as: “Can you describe how you understand the concept of patient involvement?” (see Supplementary file A). The purpose was to let the participants express their opinions about the concept freely, capturing both implicit and explicit assumptions [11]. The interviews were conducted face to face in a hospital office and lasted approximately 1 h. The interviews were recorded and transcribed immediately afterwards. The quantitative data were collected via a survey that assessed healthcare professionals' perceptions and experiences of patient involvement. The survey items were based on previous questionnaires developed by the Danish nurses' organization and the Danish medical doctors' association in 2014 [12], with a few adaptions to suit the current study context. The adapted survey was piloted with 12 healthcare professionals to ensure clarity and relevance. The survey was designed in and distributed via SurveyXact.

5. Data Analysis

A qualitative content analysis with a hermeneutic approach was chosen for the study. The approach was chosen to gain a deeper understanding of the content by describing the phenomenon in a conceptual form. Content analysis was conducted as a dynamic process. First, the transcripts were read to gain a deeper understanding of the participants' descriptions and answers to the questions [13]. Subsequently, meaning units and categories were identified to fulfil the aim of the study [13] (Table 1). Data were coded by the first author across the transcriptions using NVivo, with codes generated inductively from the data and the process following the hermeneutic circle. Consistent with a hermeneutic approach, the analysis involved interpreting both manifest content and latent meanings, moving beyond description to consider the underlying assumptions expressed in participants' accounts [13]. As Graneheim and Lundman [13] note, texts can carry multiple meanings, making qualitative content analysis well suited to secondary analysis with new research questions. The analysis process was repeated until a satisfactory level of abstraction was reached. The quantitative survey data were analysed descriptively with numbers and percentages; this was done in STATA. The interpretations presented in this study were shaped by the research team's perspectives as clinicians and researchers with experience in patient‐centred care. Regular team discussions and reflexive consideration of the coding process and potential biases were used to enhance trustworthiness and mitigate the influence of preconceptions on the analysis.

TABLE 1.

Example of analytical process.

Analysis question	Meaning units	Meaning condensation	Category	Summary of category
How do healthcare professionals understand the concept of patient involvement? How does their understanding of the concept affect their interaction with the patient?	Participant A (p. 1): “For me, it's about having the patient at the centre and involving them in decision‐making. Both ensuring that they understand, and that they make their decisions based on well‐informed grounds. (…) I may think we should initiate many treatment measures, but if the patient thinks, ‘I really don't want that’… (…) It's about involving the patient in decision‐making so that they aren't just put on the sidelines, but as much as possible, the patient remains at the center.” Participant G (P. 1): “… where we inform patients about the different dialysis options available, and then we try together to find out which dialysis type best suits the patient. It's really about quality of life—what matters most to the individual patient, what makes the most sense. (…) That's really part of my core responsibility: to inform them, while continuously involving them in the decision.” Participant H (P. 1): “It's about involving patients in significant decisions. Ideally, in all decisions regarding their disease treatment (…), which all have advantages and disadvantages, but where the patient must be involved in the choice. What is best for this patient—because it's not necessarily something I can see. It's something the patient can see for themselves.” Participant I (P.2): “You asked what I consider patient involvement… Well, it means that the patient is literally at the table, and that we are transparent about any choices, if it's a shared decision‐making process.” Participant J (P.1): “Often there isn't that much to choose from, but sometimes there are multiple treatment options, and then it's really important that, if there is something to choose from, we present it in a way that allows the patient to ask questions and understand it. (…) So, it's about involving them as much as possible, so they can make a sound and well‐informed decision regarding what they want from the options we can offer.” Participant (P. 3): “In some cases, they do have choices. We present our perspective, they present theirs, and then we make the decision together.”	The patient should be placed at the centre so they can participate in making an informed decision The patient must be informed about available treatment options to be able to participate in decision‐making. Patients should be involved in the decisions related to their treatment process. Decisions should be made jointly between the patient and the healthcare professional. Patients should be informed so they are able to make decisions together with the healthcare professional. Decisions should be made collaboratively when the patient has multiple options.	Patient involvement occurs when patients are part of the decisions.	Patient involvement is about including the patient's opinions and reflections in the decisions made regarding their treatment process. Healthcare professionals possess knowledge about treatment and can therefore inform patients about their course of care, treatment initiatives, symptoms, etc. This information provides patients with the foundation to participate in decision‐making. When patients are to take an active role in the decision, their opinions must be included, and their perspectives are essential information that enables them to participate in making decisions about their treatment.

6. Institutional and Ethical Approvals

In accordance with Danish law and The Danish Healthcare Act §42, interviews and surveys of this nature do not require formal ethics committee approval. All interview participants were informed about the study verbally and in writing before giving written consent to participate. The consent covered use of the data for future publications. Survey participants consented by completing the questionnaire. All data were kept in secure systems, and participants were anonymized. Confidentiality and anonymity were ensured, and all data were stored in secure systems with access limited to the research team. The study was conducted in accordance with the principles defined in the ethical principles for research [14].

7. Sample

Quantitative data were provided by 1214 survey respondents, and qualitative data came from 12 healthcare professionals, all from different hospital wards at AUH in Denmark. The participants represented a diverse mix of professions, clinical experience, and roles, providing a broad perspective on patient involvement (Table 2).

TABLE 2.

Characteristics of interview and survey participants.

Characteristics of interview participants (n = 12); named A–L in quotes
Gender	n (%)	Professions	n (%)	Years of experience Mean (SD)	Distribution across hospital departments	n (%)
Female	11 (91)	Nurse	6 (50)	23.3 (8.6)	Respiratory centre	2 (17)
Male	1 (8)	Medical doctor	3 (25)		Neurology	1 (8)
		Physiotherapist	2 (17)		Infectious diseases	3 (25)
		Dietitian	1 (8)		Nephrology	2 (17)
					Plastic surgery	1 (8)
					Cancer	3 (25)
Characteristics of survey respondents (n = 1214)
Female	1025 (84)	Nurse	671 (55.3)	18.4 (15.3)	Heart and lung diseases and surgery	159 (13)
Male	178 (15)	Medical doctor	272 (22.4)		Anaesthesia and surgery	156 (13)
Other	11 (1)	Clinical laboratory scientist	90 (7.4)		Cancer	86 (7)
		Physio‐ or occupational therapist	61 (5.0)		X‐ray, scan, radiation therapy, etc.	78 (7)
		Healthcare assistant	41 (3.4)		Intensive care and respiratory centre	70 (6)
		Radiographer	37 (3.1)		Gynaecology and obstetrics	59 (5)
		Midwife	26 (2.1)		Neurology and neurosurgery	59 (5)
		Psychologist	9 (0.7)		Emergency and trauma	57 (5)
`		Dietitian	7 (0.6)		Paediatrics	53 (4)
					Endocrinology and rheumatology	51 (4)
					Blood analysis and pathology	51 (4)
					Hepatology and gastroenterology	48 (4)
					Nephrology and urology	47 (4)
					Haematology and infectious diseases	43 (4)
					Orthopaedic surgery	40 (3)
					Geriatrics	29 (2)
					Physio‐ and occupational therapy	27 (2)
					Other	101 (8)

8. Results

8.1. Findings From the Survey

Survey responses are summarized in Table 3. Respondents were allowed to select up to three response options, meaning that some overlap between categories may occur; consequently, percentages should be interpreted as indicative of overall trends rather than mutually exclusive proportions. The most selected statement was that patients can influence decisions related to their care and treatment plans (69%), followed by asking patients about their needs, preferences, and knowledge (60%). A significant number also identified patient education (37%) and informing patients about illness and care (45%) as key factors for patient involvement. The results suggest that healthcare professionals perceive patient involvement in multiple ways, reflecting a spectrum of understandings encompassing decision‐making, communication, education, relational aspects, and teamwork, rather than a single, uniform interpretation.

TABLE 3.

Survey respondents' reporting of their understanding of patient involvement.

I understand patient involvement as…*	N (%)
The patient being able to influence the decisions related to their care and treatment plans	843 (69)
Asking the patient about their needs, preferences, and knowledge	725 (60)
The patient's knowledge and preferences are used to plan their treatment	611 (50)
Informing the patient about illness, treatment, and care	544 (45)
Educating the patient to handle their illness	447 (37)
The patient being active in their care and treatment plans	442 (36)
Having a good relationship with the patient	342 (28)
Having an interprofessional collaboration in teams around the patient	294 (24)
The patient participates in surveys	46 (4)

^*Each participant could choose 3 options.

8.2. Findings From the Interviews

The analysis of the interviews revealed four key themes. These themes are examined in detail in the following section, directly addressing the study's aim and contributing to a deeper understanding of how healthcare professionals understand patient involvement and how this influences their interactions with patients.

8.3. Patient Involvement Occurs When Patients Are Part of Decisions

Interview participants described the concept of patient involvement as encompassing several elements. A consistent view was that patient involvement was about enabling patients to be involved in making decisions related to their illness trajectory.

"It's about putting the patient at the center and involving them in decision‐making… so that they are not sidelined, but as far as possible placed at the center." Participant A, nurse.

This illustrates how participants viewed involvement as an ethical commitment to ensuring patients' voices remain visible within clinical processes. Healthcare professionals perceived patient involvement as a key aspect of making sure clinical decisions are based on what patients want. The healthcare professionals could support the patients in all decisions, ensuring these were grounded in the patients' views and needs. These decisions could range from minor aspects of patients' care to significant decisions regarding treatment plans. The healthcare professionals reported that, for patients to play an active role in decision‐making, their opinions had to be regarded as equal and considered alongside those of the healthcare professionals.

"It's involving patients in important decisions. Optimally all decisions regarding their treatment, all of which have advantages and disadvantages. What's best for this patient isn't necessarily something I can see. It is something the patient can see for himself." Participant H, nurse.

This quote highlights how professionals recognized the limits of their own perspective and acknowledged patients' experiential knowledge as central in decision‐making. The healthcare professionals found that the ideal scenario occurred when patients actively participated in decision‐making, as they were the ones who understood their own needs best. Furthermore, the healthcare professionals had knowledge rooted in professionalism and experience, but which was not always tailored to a patient's unique situation. Therefore, it was crucial to let the patient be an active participant in decision‐making.

"We have some things where they can choose… We present our world, and then they can present their world. Then we will make a decision together." Participant K, allied health professional.

This statement reflects the healthcare professional and the patient sharing knowledge and thoughts prior to making a shared decision. A dialogue was established, which fostered mutual respect and understanding. In addition, it acknowledged that both contributed valuable insights to the decision‐making process. This approach would consider both the patient's unique perspective and situation, and the healthcare professional's expertise, leading to a more comprehensive and personalized decision‐making process.

8.4. The Interaction With the Patient Is About Establishing a Partnership

It was important for the healthcare professionals to establish a relationship with the patient where the collaboration between them was paramount. One said: “to signal that I am here with you about this, it is a collaboration…” (Participant E, nurse). A partnership also seemed to benefit the patients. According to the healthcare professionals, when collaboration was established on the patient's terms, the patient had a greater opportunity to share their opinions and thoughts in interactions.

"Somehow you almost become an equal partner. Of course, we possess a professional knowledge that they do not have, and I know what I need to teach them for me to vouch for sending them home with the treatment. But still, we try as much as possible for it to be on the patient's terms." Participant G, allied health professional.

For the healthcare professionals, partnership was an important condition for patient involvement. However, the responsibility fell on the healthcare professionals if the patient expressed little need for involvement. The healthcare professionals found that some patients wanted very little involvement. This could present something of a challenge to the process and partnership because these patients also wanted very little communication. In such cases, the healthcare professionals bore the responsibility for listening to the patient and adapting the process to their preferences. This also highlights an ethical tension, as tailoring information to avoid overwhelming patients may unintentionally limit their autonomy, requiring careful reflection on how to balance protection and participation.

"We also sometimes experience that there are actually some patients who want to be involved very little, where it can actually be really difficult to get this process started." Participant F, allied health professional.

The healthcare professionals found it important to listen to the patients no matter what the patients might think or need in terms of their preferences: “Open for questions, it could be something important for the patient” (Participant B, medical doctor). The healthcare professionals also found it important to allow the patients to talk about what was important to them, regardless of whether this fitted into the procedure or not. Despite the movement toward a partnership, the healthcare professionals acknowledged the asymmetry in the relationship. The healthcare professionals possessed knowledge and skills that the patients did not have. Becoming an equal partner with a patient involved actively listening to the patient's concerns, understanding their personal life, and integrating their inputs into the care and treatment plan. It became evident that healthcare professionals sought to build relationships with patients by approaching interactions as collaborative endeavours.

"During the very first meeting, it's extremely important for me to signal that I'm here with you about this, it's a collaboration, I don't know any better than you do, but I believe that we can figure this out together." Participant E, nurse.

The above statement reveals how the healthcare professionals tried to show patients that their opinions were an important part of a partnership and a foundation for shared decisions. However, the collaboration required that the healthcare professionals made an active effort in the interactions to establish the partnership. According to the healthcare professionals, not all patients could articulate their own needs by themselves.

"Not all patients have the resources to muster preparation or articulate their needs. It will then require more active work from us as healthcare professionals. Set the stage so that you do not go wrong with the measures you take, but actually clarify during a conversation whether the goals you set, the treatment goals, and health initiatives are realistic and can be implemented where the patient is." Participant F, allied health professional.

The above statement illustrates that healthcare professionals were aware that some patients had a greater need for support in the interactions. The findings imply that healthcare professionals had to take the initiative to create an environment conducive to patient involvement. This involved not only setting the stage for an open dialogue, but also ensuring that the care and treatment plans were practically feasible for the patient. Therefore, the healthcare professionals spent time asking about the patient and gaining insight into their situation. The findings show that collaboration was a relatively recent development in healthcare, as indicated by one healthcare professional who suggested a shift in their perspective concerning collaboration with patients.

"Before it was a little ‘we know best.’ We decided the treatment plan. In the past, you didn't do things as nuanced as we do today, where the patient is included and we say, ‘What do you think about this?’ Now, the patient also has an opinion and that opinion must be taken seriously." Participant J, medical doctor.

The above statement reflects that, in the past, there has been a tendency for the healthcare professionals to decide on plans for care and treatment alone. Findings from this analysis suggest that healthcare professionals now found it important to make decisions in collaboration with patients.

8.5. The Patient's Lifeworld Is Important for Patient Involvement

This theme highlights how healthcare professionals tailor information and communication to align with each patient's lifeworld, which can involve a more one‐directional form of guidance compared to mutual dialogue. The healthcare professionals recognized that each patient is unique, with varying needs when it comes to their involvement in care and treatment. They emphasized the importance of meeting patients where they are, considering their individual lifeworld. Patients differ in education, resources, and understanding of their condition. According to the healthcare professionals, it was important to gain insight into the individual person they were interacting with, allowing them to tailor their communication and information accordingly. Patient involvement, therefore, also meant listening to the patients' needs and preferences, and being able to connect with their lifeworld.

"And there are also different ways to communicate. To find out what kind of person I'm sitting in front of. Is it a highly educated person who has read a lot, and has good knowledge about their disease, and has good disease insight? Or is it a socially vulnerable person who does not have as many resources? It is important to communicate with the socially disadvantaged so that there are not a lot of high‐flown words, but it is very brief and concrete." Participant A, nurse.

This approach allowed the healthcare professionals to tailor communication and information to each patient's background and capabilities, fostering a form of patient involvement that was truly patient‐centered. The healthcare professionals were aware that the patient's decisions about treatment and care had to fit with their everyday life. The healthcare professionals also noted the importance of actively listening to the patient to ensure the information provided suited their needs. By listening closely, healthcare professionals became aware of what mattered most to each patient. Furthermore, the healthcare professionals found that providing ongoing information was essential for adapting to the patient's changing needs and expectations. As the patient gained more understanding of their condition, healthcare professionals could adjust the level and detail of their information, ensuring it remained relevant to the patient's lifeworld and current situation.

"So it doesn't become a standard approach, but rather one where the patient's preferences are clear. Their life is reflected in the guidance, rather than it being generic and standard. That's a different approach, but I see it as a form of patient involvement where the patient helps determine what information they need." Participant I, nurse.

This open approach highlighted that patient involvement also meant being attentive to individual preferences, allowing for guidance that was personal rather than standardized. Engaging in personalized dialogue, such as asking: “What do you think about your condition?” (Participant L, medical doctor), helped the healthcare professionals gain a deeper understanding of the patient. In this way, the healthcare professionals could ensure patients had both an understanding of potential outcomes and a voice in the process, making sure the decisions were informed by what was most relevant in each patient's life. Spending time with patients in this way provided a strong foundation for patient involvement, as the healthcare professionals could adapt their guidance and information to suit each patient's unique situation and preferences. An open approach during meetings with patients fostered a movement toward a more patient‐centered starting point, focusing not only on the disease, but also on the patient's lifeworld.

"We talk a lot about life at home and lifestyle changes. It is actually important to get them involved in what they can possibly do, and what they want to do." Participant C, nurse.

This approach, rooted in listening and learning about each patient's lifeworld, enabled the healthcare professionals to adapt their communication and information to meet patients' individual needs.

The healthcare professionals acknowledged that discussing the patient's lifeworld and understanding their thoughts about their condition were essential to meaningful patient involvement. The continuous provision of tailored information also empowered patients to make decisions that aligned with their values and lifestyle, supporting them in becoming more actively engaged in their care and treatment. Through these personalized interactions, they could build a foundation for care that truly centred on each patient's life, values, and capabilities.

8.6. Professional Authority and Information Framing

When healthcare professionals interacted with patients, they were aware that they possessed knowledge that patients did not have access to unless it was provided to them. Therefore, the healthcare professionals could influence patients in a particular direction, depending on what the healthcare professionals thought would benefit the decision‐making. This dynamic could establish an inherent imbalance in the interactions, where healthcare professionals' expertise places them in a position of influence over patients' perceptions, understandings, and ultimately their choices.

"We also have an agenda which is not always completely visible to the patient, but which is very visible to us." Participant H, nurse.

Healthcare professionals held a position of authority and knowledge that allowed them to subtly steer patients toward certain decisions. This authority is not merely a matter of guiding decisions but also involves selectively curating information that aligns with what they believe will result in the best choice from their professional perspective.

The healthcare professionals found that they had the power to adapt the information and steer the conversation in a certain direction. Using selected information, they could thus influence the choices the patients made. Based on their professional knowledge and experience, healthcare professionals could have an opinion on what was best for the patient. In some cases, this selective disclosure could result in a scenario where patients feel informed yet are unknowingly nudged towards a particular choice.

"We have a very clear opinion on which treatment is best. That means that the information we give to patients can be twisted a little bit in the sense that it increases the chance that the patient will make the choice we want." Participant H, nurse.

Despite the potential for influencing patients' decisions, healthcare professionals seemed to recognize their ethical obligations. They reported that providing honest information was important when interacting with patients. While they could influence and control the interaction, they tried to maintain transparency and honesty, ensuring that patients made decisions on the right terms. This highlights the ongoing tension between professional authority and ethical transparency, as healthcare professionals must continuously navigate how much guidance to provide while respecting patient autonomy. Some participants described occasions when patients resisted guidance or questioned recommendations, illustrating that authority is not absolute and that negotiating autonomy can be contested. These conflicting or unexpected responses highlighted the need for careful reflection on the ethical use of professional influence. However, participants did not describe any explicit criteria or structured approach for determining whether their actions were ethically sound; rather, their accounts reflected a general moral commitment to acting in the patient's best interest.

"But information must be real, it must be actual choices. You must be transparent about decisions. If it is a big decision the patient must make, then you really must be transparent with what consequences it can have." Participant I, nurse.

The healthcare professionals also found it important to allow patients time to process information and reflect on their choices. Giving the patient space and time allowed them the opportunity to think and consider all the information.

"I believe one of the most important factors is having the time to sit down and give patients the space they need. Sometimes, after a period of silence, they'll share something significant or come to a realization. It's in those moments that you get the clarity to say, 'It's clear you should continue,' or 'Perhaps it's time to stop and focus on something else." Participant J, medical doctor.

The healthcare professionals found that a pause during a conversation could be important for the patient's further care and treatment. It also allowed patients to reflect on their thoughts regarding their care and treatment plans. These pauses, while inherently straightforward, serve as powerful tools for patient empowerment. They invite the patient to actively engage in the decision‐making process and reaffirm their role in guiding their own care.

9. Discussion

The qualitative interviews expanded on the survey findings, providing rich context for healthcare professionals' responses. While the survey indicated that only a proportion of respondents recognized certain aspects of patient involvement, the interviews revealed how these practices were enacted in everyday clinical interactions, highlighting nuances not captured by the survey. By combining these two data sources, the study offers complementary insights that both confirm trends observed in the survey and deepen understanding of how healthcare professionals interpret and enact patient involvement in practice, particularly in relation to person‐centred ways of interacting with patients. These findings also illustrate an important distinction between patient involvement as specific actions and patient involvement as a relational process.

Findings show that healthcare professionals hold varied beliefs about patient involvement, yet share some common views, as outlined in the background section. They believe that collaboration with patients fosters a patient‐centred approach, making patients active participants in decision‐making. Similarly, Sieck et al. [15] emphasize that partnership between patients and healthcare professionals is crucial for effective patient involvement. However, the survey in this study showed that only 36% of respondents identified patient involvement as patients being active in their care and treatment plans, suggesting a gap between the general perception of collaboration and its practical recognition among professionals. This gap may also reflect the challenge of translating person‐centred ideals into everyday clinical routines.

Only 28% of respondents identified patient involvement as meaning having a good relationship with the patient. However, the interviews revealed that the healthcare professionals did indeed foster good relationships through their interactions with patients. The healthcare professionals invested time and resources in building collaborative relationships with patients, notably by informing them about care and treatment options during their interactions. This seemed like an important foundation for involving the patients. This aligns with Sieck et al. [15], who highlight that the time spent informing and educating patients positively impacts their experience. These efforts demonstrate how the system and healthcare professionals promote patient involvement [15]. Furthermore, healthcare professionals clarify patients' care and treatment options, which, according to Sieck et al. [15], enhances patients' perceptions of support for their involvement. Such relational efforts resonate with caring science perspectives, where authentic encounters and relational ethics are central to supporting patient autonomy.

This study also highlights that healthcare professionals recognize each patient's unique needs, stressing the importance of tailoring information and interactions to individual circumstances. Effective communication is essential to ensure that the information provided is understandable and relevant to each patient. Epstein et al. [16] emphasize that good communication enhances patients' experiences of care and treatment throughout their illness. Research further suggests that effective communication is also vital for healthcare professionals, fostering collaboration and decision‐making with patients [16, 17]. While about half (45%) of the survey respondents identified providing information as patient involvement, the interviews revealed that simply sharing information is not enough; it must be personalized to the patient's specific situation for it to be truly effective. This reflects a lifeworld‐oriented approach, where understanding patients' lived experiences guides how information is shaped and shared.

The findings of this study can also be interpreted through the lens of caring science literature [18]. Healthcare professionals' efforts to build relationships, tailor communication, and ethically manage power asymmetries reflect core principles of these approaches, emphasizing respect for patients' dignity, autonomy, and individual experiences. This theoretical perspective provides a framework for understanding how patient involvement is enacted in practice beyond the implementation of structured interventions. It also draws attention to the moral dimension of care, where relational ethics underpin how professionals support patient involvement.

In this study, communication was identified as crucial for understanding patients. The healthcare professionals learned about patients' resources, such as their education level and socioeconomic status, which significantly influenced their ability to be involved in their care. This aligns with existing literature on the relationship between health literacy and patient involvement [19, 20, 21]. The survey showed that 50% believed that a patient's knowledge and preferences should be used to plan treatment. Despite the recognition of communication as essential for understanding patients' backgrounds and needs, the survey results suggest a disconnect between this understanding and its practical application, as only half of the respondents reported that patients' knowledge and preferences were used to inform treatment planning. Patients with low health literacy often struggle to meet the healthcare system's demands and participate in decision‐making [20]. Therefore, healthcare professionals must invest time in understanding each patient's circumstances and health literacy to enhance their involvement. Unmodified information may hinder patients' ability to meet healthcare expectations, creating barriers to their overall care experience [21]. Recognizing patients' lifeworld conditions thus becomes essential for enabling meaningful involvement. Additionally, the findings indicate that not all patients desire the same level of involvement. Some prefer minimal engagement, and healthcare professionals believe it is essential to accommodate these varying preferences by adjusting their interactions accordingly [22]. A person‐centred approach supports such flexibility, respecting individual preferences and capacities.

This study also highlights healthcare professionals' awareness of the inherent asymmetry in their relationships with patients. This imbalance is seen as arising from healthcare professionals' expertise and knowledge, which patients can only access through them. There is also an asymmetry arising from the patient's lifeworld and experience, which professionals can only access through proactive discussion and analysis of its relevance to their clinical reasoning. According to Westerink et al. [23], if this asymmetry is handled unethically, it can negatively affect patients' experiences. Such situations might lead to patients losing confidence in their own capabilities if the power dynamics become too pronounced [23]. However, the study suggests that healthcare professionals are mindful of this asymmetry and seek to manage it to benefit patients. This ethical awareness aligns with relational ethics, where attentiveness to power and responsibility shapes how professionals engage with patients' vulnerability.

Healthcare professionals also recognize that they can influence patients' decisions by selectively presenting information. While some patients may view this as unethical [23], others may find value in the guidance provided by healthcare professionals. Our findings highlight the ethical complexity of healthcare professionals' influence on patient decisions, underscoring the need to balance guidance with respect for patient autonomy and to critically reflect on the use of power in clinical interactions. Caring science perspectives emphasize such ethical balancing, drawing attention to the relational nature of decision‐making. This dynamic also raises questions about whether such influence might be perceived as paternalistic, emphasizing the need for transparency to support genuine shared decision‐making. These dynamics are shaped not only by individual professionals' choices but also by structural factors such as organizational hierarchy, information access, and institutional workflows, which can constrain or enable ethical transparency and meaningful patient involvement. Findings also underscore the importance of transparency and honesty in sharing information to empower patients to make informed decisions. While the User‐Involving Hospital project at AUH aimed to systematize patient involvement through structured interventions [6], this study suggests that a purely systematic approach is insufficient. Holm et al. [9] confirm this, showing that while healthcare professionals are generally motivated to adopt systematic approaches, communication remains central to achieving effective patient involvement. This further supports caring science insights that patient involvement unfolds within relational encounters rather than primarily through standardized tools.

Ultimately, this study indicates that the degree of patient involvement depends on healthcare professionals' actions and the dynamics of their interactions with patients. Healthcare professionals play a key role in sharing information and knowledge, which aligns with Westerink et al. [23], who note that levels of support and responsibility from healthcare professionals significantly impact patients' experiences of involvement. Through communication, healthcare professionals gain insights into patients' needs, resources, and preferences, allowing for a more individualized approach that facilitates patient involvement. This underscores a person‐centred understanding of care, where the patient's lifeworld guides the supportive actions of the professional and can impact their clinical reasoning and judgements about the appropriateness of subsequent management.

10. Limitations

Utilizing a multi‐methods approach, combining both qualitative and quantitative data, strengthens the analysis by providing multiple perspectives on the concept of patient involvement. Through the integration of different types of data, a more comprehensive and nuanced understanding can be provided, capturing both the depth and breadth of patient experiences and interactions.

This study used qualitative content analysis to gain deeper insights into healthcare professionals' experiences of patient involvement and its impact on their interactions. The data were collected for another project, meaning that the first author did not conduct the interviews [9]. This limited the interpretation of the latent content, such as the informants' facial expressions and gestures, which were not observed. However, this distance may have provided new insights, free from the potential bias of the interviewer‐interviewee relationship. While the study included 12 interviewees, which we considered sufficient to capture a broad range of perspectives, we acknowledge that a larger sample might have yielded additional insights. Additionally, the majority of participants were female, which may have influenced the perspectives captured in this study and could limit the representativeness of views on patient involvement across all healthcare professional groups. A limitation of the study is that the healthcare professionals participated voluntarily, likely indicating an interest in patient involvement. While the diverse sampling strategy is a strength, including more informants from additional hospital departments could have enriched the descriptions. Additionally, incorporating patients into the study could have provided valuable comparisons between healthcare professionals' and patients' understandings of patient involvement. Despite these limitations, the findings may be applicable to other hospitals in Denmark due to the national emphasis on patient involvement.

11. Implications for Clinical Practice

This study provides insights into how healthcare professionals can improve patient involvement in clinical settings. Firstly, the finding that patient involvement is not perceived uniformly highlights the need for further training to align healthcare professionals' practices with the principles of patient‐centred care. Effective communication plays an important role, as it allows healthcare professionals to tailor their interactions based on patients' individual circumstances, health literacy, and preferences. This helps to ensure that patients can meaningfully participate in decisions about their care and treatment. In addition, fostering strong relationships and providing clear information about treatment options not only improve patient experience but also encourage collaboration. However, the study also highlights that healthcare professionals must ethically manage the inherent power asymmetry in their relationships with patients, ensuring transparency and empowering patients in the decision‐making process. By recognizing the different needs and preferences of patients, healthcare professionals can adapt their approaches to ensure that all patients feel supported and involved, regardless of their desired level of involvement.

12. Conclusion

This study reveals that healthcare professionals at AUH hold distinct perspectives on patient involvement, emphasizing patient‐centredness, collaboration, and tailoring interactions to patients' individual circumstances, health literacy, and needs. Patient involvement is enacted through shared decision‐making, meaningful engagement, and transparent communication, with healthcare professionals playing a central role in supporting patients' understanding and participation. Future research should incorporate patient perspectives to explore alignment between theoretical definitions and clinical practice and evaluate interventions to enhance professionals' skills in facilitating meaningful patient participation. The findings can also inform concrete measures, such as clinical guidelines or training programs, to translate patient involvement from concept to practice, strengthening both practical relevance and policy impact.

Author Contributions

Frederikke Andsbjerg Johansen: Conceptualization, Formal analysis, Investigation, Methodology, Project administration, writing original draft. Lotte Ørneborg Rodkjær: Visualization, Project administration, Supervision, Review and editing. Hilary Louise Bekker: Supervision, Review and editing. Anna Holm: Data curation, Investigation, Visualization, Project administration, Supervision, Review and editing.

Funding

This study was supported by the Research Centre for Patient Involvement (ResCenPI) through a start‐up grant from the Central Denmark Region (no specific award/grant number). The funding agreement ensured the authors' full independence in study design, data interpretation, manuscript preparation, and publication. The following author(s) are affiliated with the sponsor: Research Centre for Patient Involvement interventions.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Data S1: Supporting Information.

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.