Table 1

Decision-making levels

Level	Description	Examples from study transcripts
Basic	Discussion of patient’s role in decision-making	Surgeon: “Let me just be really clear. The decision to operate is your father’s … and it’s my responsibility to give you what I think is my best advice.”
	Explanation of clinical condition	Surgeon: “Now, an aneurysm is your major blood vessel’s supposed to be this big. When it gets in — like an aneurysm, it gets bigger. It gets big enough it’ll burst.”
	Assessment of patient preference	Patient: “So that should be — with those kind of odds it sounds that I should have one”

Intermediate	Discussion of risks and benefits	Surgeon: “… my real reason for doing it would be to prevent you from having a stroke.”
	Discussion of alternatives	Surgeon: “So that’s number one. Um, you know, if — a — and — and this sort of comes down now, more to the lifestyle issue as opposed to anything else, because in terms of operating for this, if we did nothing — ok, if we didn’t operate and you quit smoking, then the risk of losing a leg or something here, is relatively low. It’s only about 1%– 2% per year.”
	Assessment of patient understanding	Surgeon: “What do you think the risks are of the surgery that I’ve described to you?” Surgeon: “Do — do you understand what I’m saying?”

Complex	Discussion of uncertainty about decision	Surgeon: “Now, we have to — you know, we’re looking at balancing here the risks of doing something and the risks of doing nothing. And this is what we had talked about — uh, when you were in my office before.”