Symptom severity may play an important role in the treatment decision-making process among Black patients with carpal tunnel syndrome who are considering surgery. However, social, cultural, and financial considerations could influence whether patients pursue, delay, or decline treatment, according to a recent study.
In the qualitative study, researchers conducted semistructured, one-on-one interviews with 28 Black patients who had carpal tunnel syndrome (CTS) recruited from an outpatient hand surgery clinic in the Midwestern United States and a patient clinical research registry. The participants had a mean age of 47 years, 82% of them were women, 57% of them were younger than 50 years, and 39% worked in manual labor occupations. The primary outcome was the identification of factors associated with decisions to pursue, delay, or decline surgery. Through thematic analysis, the researchers identified four interrelated themes: embodied threshold, relational autonomy, cultural and social influences, and economic insecurity.
Worsening symptoms and declining hand function were the primary factors prompting the participants to consider surgical intervention. Many patients reported tolerating mild or intermittent symptoms for prolonged periods but reconsidering treatment when their pain became persistent; sleep was disrupted; or hand dysfunction interfered with work, personal care, and daily activities. The participants described reaching an embodied threshold at which loss of function and independence outweighed reluctance to undergo surgery.
The researchers found that patients valued maintaining control of their bodies and the decisions surrounding treatment. The participants described preferring physicians who presented information and recommendations without pressure, allowing them to make informed choices at their own pace. Collaborative and respectful communication as well as transparent discussions were associated with greater trust and engagement during surgical decision-making.
Cultural and social influences emerged as recurring themes. The participants reported relying on family members, friends, coworkers, and community networks when evaluating surgery as a treatment option. Experiences shared by trusted peers often shaped perceptions of surgical risks and benefits and influenced how patients interpreted medical advice.
Patient-physician cultural and racial concordance was also associated with trust and comfort during clinical encounters. Several of the participants reported feeling more confident and less anxious when treated by physicians who shared their racial background. The patients viewed these interactions as contributing to feelings of being understood, respected, and believed.
Financial concerns frequently influenced treatment timing. The participants described worries about lost wages, unpaid leave, job security, and out-of-pocket medical expenses. These concerns sometimes contributed to delays in surgery even when patients believed their symptoms warranted surgery.
The study had several limitations. The sample included just 28 English-speaking patients from a limited geographic region, and some participants were recruited through social media. In addition, the qualitative design was intended to explore experiences and perspectives rather than determine the prevalence of specific factors or establish causal relationships.
Overall, the findings suggested that decisions about CTS surgery among Black patients may reflect the combined influence of symptom severity, autonomy, community experiences, physician relationships, and financial constraints.
"Participants navigated hand dysfunction, loss of independence, community narratives, and financial pressures to make their treatment decisions," wrote lead study author Amore Jackson, of the University of Virginia, and colleagues. "By centering the voices and needs of Black individuals and other marginalized populations, surgical care can become more equitable, effective, and attuned to the realities of those it serves," they concluded.
The study authors reported no conflicts of interest, and no funding information was included in the study.
Source: JAMA Network Open
