Table 2.

Levels of Surgeon-Perceived Preoperative Buy-in for Postoperative Treatments

Types of Buy-in	Surgeon		Patient
	Description	Representative Quotes	Description	Representative Quotes
Explicit buy-in	Surgeon states the performance of surgery is contingent on a preoperatively determined agreement between surgeon and patient about participation in postoperative treatments.	MD: “If we decide we're going to be there, then you and I have sort of a verbal contract that we are going to do everything that we can to have that outcome that we want. So if we're going to go forward with that, then we have an understanding that everybody is going to do their utmost.”	Patient states that the surgeon can do whatever is necessary around the time of surgery.	PT: “You do what you have to do,” MD: ...It's understandable to be nervous because it's a big surgery. PT: But I have complete faith in you. MD: Okay, I know you're anxious about this but we have to take it a step at a time. PT: I understand. You're the boss!
Implicit buy-in	Surgeon emphasizes that the patient will participate in prolonged or unexpected treatments if necessary.	MD: “We are going to do the operation that Friday and then you're here in the hospital as long as you need to be, and that's the bottom line, right? If you need to be here longer, you're here longer...” MD: “Sometimes it turns into a war and you have to fight battles to win the war, so you have to be prepared for that on some level.”	Patient notes a general recognition that death and other complications will be accepted or tolerated.	PT: “That's God's will, I've led a good life.” PT: “Yeah, okay. So that's it. The lifestyle changes, you adjust to it, you know.”
Assumed buy-in	Surgeon assumes that the patient agrees to postoperative care by acknowledging surgical risk.	MD: “And this is a form that basically says that we've gone over the risks.... And that you agree to go forward. It's not a contract, by any means. You can always just not show up.”	Patient states a willingness to proceed with surgery and acknowledgment that risks exist.	MD: “Yeah, and I think... I mean there are risks to it of course...” PT: “Yeah. There's a risk to everything.” PT: “I think I'd like to have you do the surgery.”