Table 3.

Surgeons' presentation of treatment options for very frail patients.

Choice Presentation	Rationale	Quotes
No choice Surgery is not offered	Outcome is unacceptable Professional duty to avoid burdensome treatment	“If you're not going to survive, you're not going to survive, and there's really no reason to take someone to surgery to do an autopsy and, you know, send the bill to Medicare.” “And one of the things I always tell them is that surgery is not a success if you just make it through an operation and are disabled the rest of your life. That's not successful surgery.”
Biased choice	Surgeon has decided patient should not have surgery Frames the decision to favor non-operative strategy	“I mean, you, we've made our decision that probably this patient really doesn't warrant a surgery …And so you make that decision when you go see that patient, and you're going to steer the patient and the family in the direction of conservative [treatment]”
Simple choice	Patient/family to decide based on options presented Surgeon suppresses/does not present own opinion about value of surgery	“Well, I don't think anybody in this room thinks [she should have an operation], and yet, we keep talking about presenting her with the choices.” “… I see my job to try and help them understand what their options are. Their job is to choose, you know.” “But usually, I won't tell until patients ask my opinion.”