Table 2.

Informational and decision support failures identified in qualitative data by the PFAC.

Perception	Qualitative Study: Preoperative Interview	Qualitative Study: Postoperative Interview	PFAC Discussion
Surgery “has to be done”	I didn’t really decide I wanted to have it… after all those tests…sent me to the heart surgeon… he said, well it should be done.	… there wasn’t really any other options, and then so, you know, there wasn’t uh, nothing to think about really.	Patients need more information about alternatives. Patients “already have one foot into the surgery room” because the surgical referral process implies that surgery is the only option. Patients may still conclude surgery “has to be done” but need to have more information about what would happen if they did not have surgery.
	I don't know. Just get it done and go on with your life, I guess.	But, you know, what, what’s the option? Um, do you not have the surgery and wait for a heart attack and then your recovery is going to be a whole lot more complicated and probably protracted…So, to me it was like a no brainer, you know.
Surprise: recovery is arduous	Just to fix the problem which I am having…That is my expectation.	Hey if I’m gonna feel like I got hit by a truck, tell me before. So it was more, it was more intensive… than I realized it would be.	Patients are not fully prepared for the intensity of surgery and the recovery process. Patients should know what to expect postoperatively. Patients who are surprised postoperatively may be upset with the surgeon.
	[Surgery is] going to be the easiest, best opportunity for me to live a couple more years…It's just a little treatment here and there afterward.	I thought it was going to be an in and out thing.
Unclear advance directive	They just know what they got to do. I don't want to be laying around being a vegetable.	Should I let him go ahead and do the CPR? …I didn't want to put him through that… It's the hardest decision I've ever made.	Patients do not have the opportunity to clearly express their preferences for postoperative life supporting treatments. PFAC member:“There is a disconnect between what the patients want and who is the right person to tell these wishes” to.
	Yeah I think [the surgeon] knows [what to do in an event of a complication]…Whatever he thinks is best.	…if you were going to get good results, it’s one thing, but if you’re going to come home and do nothing… stick your finger in a light socket.