Table 3.

Provider and administrative quotes

Theme	Quote
The overall opinion of the SURPAS tool	“If I knew that if I did this [used SURPAS] and that it showed my patient is much higher risk than I had previously thought,[and] if there’s something I can do that’s going to lower that, then that’s a motivator.” - Surgeon
The overall opinion of the SURPAS tool	“I think the things that I like about it [SURPAS] is it takes something that’s incredibly challenging to do, both from the physician side and from the patient side, one, to be able to tell the story, and two, is for a patient to be able to understand the story. It makes it simple on both ends so it’s not a lot of work for the physician, and it’s also not a lot of work for the patient.” - Administrative Official
Implementation of the tool into a system/clinic environment	A surgeon felt it should be used, “When you’re actually really taking a serious look at all the data, tests, and the patient. I think to do it too far in advance, you miss a lot of the details in terms of decision-making.” “From an administrative standpoint, I’m interested in it for two reasons. One is we obviously want our patients to understand what they’re getting themselves into and be fully informed. This is gonna allow that to be much more likely, and that’s obviously what we want. I’ll be even more interested 5 years from now when you have the interventions because [we can] come back and say we now know that if you can quit smoking, your risk of wound infection goes down, your pulmonary outcomes will improve by blank percentage, et cetera.” - Administrative Official
Benefits to surgeons of the SURPAS risk assessment process	“This would change my decision making process; potentially thinking twice about a procedure depending on specific significant risks.” - Surgeon
Benefits to patients of the SURPAS risk assessment process	One provider described using SURPAS in a difficult decision where surgery is not recommended due to anticipated high risk of mortality and morbidity: “This [surgery] really isn’t going to make much of a difference in the outcome and we have a family wanting us to do everything.” “I think with our challenges of the population that we serve, very broad base,extremely diverse, with 120 languages that are spoken around just the hospital itself and the translation issues that we have, first of all, the interface, I think, makes a lot of sense, just showing simply, “Here’s your risk out of 100 people of what’s going to potentially happen. Now, that probably needs to be translated in other languages if we’re gonna be completely effective at just starting there, to have a way to have a conversation, even with a translator present” - Administrative Official