Table 2.

Surgeon-level themes contributing to surgeons’ use of palliative care

Theme	Subtheme	Reflective quotes
Surgeon knowledge and attitudes	Education and training	When my mom was dying, she was dying at [hospital name], and they had a palliative care team come in. And, you know, I had never heard of somebody being in palliative medicine. I just didn’t, you know, I mean, I understood what the phrase was, and I understand, but I didn’t realize that it was a specialty. It was called palliative care. I think there needs to be more education to the practicing physicians as to what those services are.
	Culture shift	So, you know, I think in the beginning of your surgical career, certainly in residency, everything can be fixed. And then as you advance, you realize many things can’t be fixed. And then with even more experience maybe some things shouldn’t be fixed.
Prognostication challenges		I’ll also say, on the flip side, I’ve had some patients that I was sure I was going to kill them, or something bad was going to happen. I felt the same way, and they did just fine. So, this uncertainty goes both ways. I think probably it’s just complex stuff with innumerable kind of well-intentioned parties, family, nurses, physicians, other’s, you know, staff, friends who all kind of are incapable of really being able to predict the future
Surgeon identity	Role as “fixers”	There’s lots of ways to take care of problems, and I don’t know how to word it any different. I’m open to, you know, palliative care, but again, as a surgeon, I’m trying to fix everybody. I mean, whenever I meet a patient, my goal is always to make them well, to take out the cancer, to get them back to their full state of health. And so it’s hard for me to not seem like I’m giving up or backing out on someone if things don’t go well.
	Personal responsibility	It feels like if you start talking palliative care to family or patients, they think, I guess in my mind I feel like they’re going to say, oh, he’s kind of written me off, and he doesn’t want to take care of me anymore. He just wants to get rid of me. Whom do they trust, you know? Whom do they, and so I would call this an underserved area. Lots of these patients, they just trust their doctors. And they say, okay, doc, you decide what’s in the best interest.