Table 3.

Patient- and family-level themes contributing to surgeons’ use of palliative care

Theme	Reflective quotes
Expectations	The problem with that too is sometimes they, again, the expectations are kind of not realistic in that they don’t think they’ll need it, and so they don’t want to talk to palliative care or hospice.
Discordance	I think that there are people whom I would have liked to not have operated on at all because they were, you know, desperately ill, and they were going to have a poor outcome. But in the end, if you have a patient and family who are hard indication for surgery and they’re demanding surgery and a delay is going to compromise their life and they might have a chance of making it out of there, then you do that. He was in and out of the hospital every couple weeks because of exacerbation of this, of the infections related to this fistula. And it was, you know, and I just felt that, I just, I felt, and I talked to him about this, that this is a risky operation, and I don’t remember how much of a risk of death I quoted him. But, you know, and but his quality of life was really poor with this illness, and he was basically willing to accept any risk for a chance at being free from this problem. But, you know, he paid the ultimate price, right? I mean, he, you know, the operation led slowly to his demise.