Table 2.

Dominant themes, sub-themes and exemplar quotes relevant to bladder cancer treatment decisions (N = 60)

Theme	Sub-themes	Exemplar quotations
My decision was based on...	Where to receive the best care and from whom	So when I have something that I think is amiss like cancer, I put on my due diligence hat and start analyzing what’s happening. And one of the things that I’ve always kept as a reference point is, where are the centers of excellence for various treatments? (71 yo M, Stage III)
		I just liked the reputation and the doctors here better and just stayed here. That was it, very simple. (79 yo W, Stage II)
	What the physician recommended	We decided that—my husband was with me again—we decided that we preferred coming here to going locally. So [Dr] did say, “We’ve got to get the tumor out right away.” So I had the TURBT surgery in December. And then he said, “I would like [you]to have a course of chemo before we proceed with the rest of the surgery.” In the meantime, I had contacted, uh, someone we knew who had had bladder cancer. I spoke to a couple people, looked at some things on the Internet, um, checked the [hospital] and people here on—on the Internet, went to their sites. And, we decided to go along. (79 yo W, Stage II)
	Chance of survival	So that’s why they decided to go this way with [patient]. They’re going to remove it completely and give him—and that’s going to give him the better chance of a long life because he won’t be able to get bladder cancer again if he doesn’t have a bladder. (Caregiver to 70 yo M, Stage III)
	Personal attributes (age, leisure and work activities)	I based it on the fact that, uh, I’m 59 so it’s not like I’m 20 and have to live with this bag for, you know, a hundred years. If I were still a young woman... I might have considered doing a rebuilt bladder simply because it’s a more natural in appearance and, uh, as long as nothing recurs I would think that it would be a good solution. (59 yo W, Stage III)
		I’ ve always been a very active person; I go to the Y two or three days a week, and I fish and I play golf. And I just figured that it was worth it to go through the inconvenience of having a bag. And it is—sometimes it’s an inconvenience, but for the most part I’ve adjusted, I think, very, very well to the fact that I’m wearing this thing. (81 yo M, Stage III)
		I’ve been an athlete my whole life. I have always exercised. I never had a period of my life where I was not exercising. Very active. So an ostomy bag really was not an option for me. (54 yo M, Stage II)
		I want to be able to move around and I want to be able to continue working. Um let’s see. Yeah...because as far as my decision making it was really um life expectancy, quality of life, reproductive sexual function, third as far as importance on the list. (33 yo M, Stage II)
Decision Control Preferences	Passive	It’s like, “No, you tell me what I’m supposed to do. I just want to live [laughs].” That was basically how I made my decision. When I met with him, and I did feel confident that he knew what he was doing. (58 yo M, Stage IV)
	Shared	I felt very involved... we even communicated with him prior to this last surgery what our desires were with respect to my bladder being so sensitive, we wanted to be a little bit more on the conservative side with surgery.... because we understood things now, and we were all in agreement (52 yo M, Stage I)
	Active	At first I thought not to do anything, and then talking to them and talking to my husband, and obviously talking to [Dr] that we all agree that I needed to do something. I think that my children and my husband really felt relief when I decided I’m committing myself to do the six weeks, because at the end I was the only one who would make the decision. (56 yo W, Stage I)
Surgery	Primary	The bladder is out; prostate is out, a bunch of fat and lymph nodes and stuff because it had gone so far through [the bladder]; he’s like, “It was pretty serious.” I didn’t have a whole lot of people to go to. I mean, a lot of people are “So-and-so had that twenty years ago, and they’re fine,” (58 yo M, Stage IV)
	Reconstructive	Back at the beginning when we found out I had the bladder cancer, it was like eventually it’s going to be a removal of the bladder. And, um, so a decision had to be made whether I would have a stoma, a bag on the outside or a rebuilt bladder. And so that was probably one of the biggest decisions I made. And in talking to the doctor, I took a lot of what the doctor had to say because he’s the expert, not me. And then I also – though I’m not very computer literate but my daughters are. (Laughs.) So they would pull information up online for me so that I could read about it at home, too, and, made the decision to go with the stoma, the bag on the outside. (59 yo W, Stage IV)

Abbreviations: yo = year old; M = man; W = woman.