Surgical Decision Making Among Black Adults With Carpal Tunnel Syndrome.

Importance: Black patients in the US face persistent disparities in surgical care, including underuse and delayed access. Little is known about how Black individuals weigh clinical symptoms against broader social, cultural, and economic factors when considering elective surgery, such as for carpal tunnel syndrome (CTS). Objective: To explore the lived experiences and priorities associated with surgical decision-making among Black adults with CTS. Design, Setting, and Participants: In this qualitative study, semistructured one-on-one interviews were performed with 28 Black individuals with CTS recruited from an outpatient hand surgery clinic in the Midwestern US and via a patient clinical research registry. Participants were asked to discuss the impact of hand dysfunction and how their experiences influenced surgical decision making. Interviews were conducted between October 1, 2023, and March 31, 2024, using a videoconference platform. Transcripts were coded and analyzed using inductive and deductive thematic analysis. Exposure: Presentation with CTS at an outpatient hand surgery clinic. Main Outcomes and Measures: The primary outcome was the identification of key factors and lived experiences associated with patients' decisions to pursue, delay, or decline surgery for CTS. Results: Among the 28 participants, 23 (82.1%) were women and 16 (57.1%) were younger than 50 years (mean [SD] age, 47.3 [14.8] years). Participants reported on their embodied threshold where increased symptom severity and loss of hand function prompted surgical consideration. To many participants, autonomy was relational, and all valued collaborative, respectful communication from clinicians. Participants reported that cultural and social influences mattered. In particular, community narratives and clinician racial concordance were associated with trust and surgical decision-making. Participants shared how economic insecurity undercut their autonomy and how their financial instability contributed to surgical delays, despite recognition of need. These experiences cumulatively informed and shaped how patients with CTS decided to undergo surgery or continue nonoperative management. Conclusions and Relevance: In this qualitative study, surgical decisions among Black patients with CTS were associated with a complex interplay of physical, social, cultural, and financial factors. Culturally tailored shared decision-making that respects patient autonomy, acknowledges financial constraints, and integrates community perspectives may reduce disparities and improve surgical engagement.