Rationale: The goal of shared decision making is to match patient preferences, including evaluation of potential future outcomes, with available management options. Yet, it is unknown how patients with smoking-related thoracic diseases or their surrogates display futureoriented thinking.Objectives: To document prevalent themes in patients' and potential surrogate decision makers' future-oriented thinking when facing preference-sensitive choices.Methods: We conducted 44 scenario-based semistructured interviews among a diverse group of outpatients with smokingassociated thoracic diseases and potential surrogates for whom one of three preference-sensitive decisions would be medically relevant. Using content analysis, we documented prevalent themes to understand how these individuals display future-oriented thinking.Measurements and Main Results: Patients and potential surrogates generally expressed expectations for future outcomes but also acknowledged their limitations in doing so. When thinking about potential outcomes, decision makers relied on past experiences, including those only loosely related; perceived familiarity with treatment options; and spirituality. The content of these expectations included effects on family, emotional predictions, and prognostication. For surrogates, a tension existed between hopebased and fact-based expectations.