Living Through Sweat: A Qualitative Study of the Pre-Surgical Decision-Making Trajectory in Patients with Palmar Hyperhidrosis

Meimei Yan,1,* Siwei Chao,1,2,* Lu Yu,1,* Chang Liu,1 Zhengjun Li,1 Liman Gong,3 Bingli Bao,3 Sibo You,1 Guofeng Zhang,1 Yi Ren,1 Guichun Du3 1Department of Thoracic Surgery, The Tenth People’s Hospital of Shenyang, Shenyang, Liaoning, People’s Republic of China; 2Department of Graduate Studies, Shenyang Medical College, Shenyang, Liaoning, People’s Republic of China; 3Department of Nursing, The Tenth People’s Hospital of Shenyang, Shenyang, Liaoning, People’s Republic of China*These authors contributed equally to this workCorrespondence: Guichun Du, Department of Nursing, The Tenth People’s Hospital of Shenyang, Shenyang, Liaoning, People’s Republic of China, Tel +86-18102486199, Email [email protected]: This study aimed to explore the dynamic and ambivalent pre-surgical decision-making process of patients with palmar hyperhidrosis (PH), focusing on the “anxiety-sweating” feedback loop and the psychological factors influencing their treatment choices, particularly the interplay between psychological distress and the decision to pursue surgery.Patients and Methods: We conducted a qualitative descriptive phenomenological study in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ). Semi-structured in-depth interviews were conducted with 19 adults who had lived with PH for more than 10 years and were considering surgical treatment. All interviews were conducted before surgery. Data were analyzed using NVivo 11 software and Colaizzi’s seven-step phenomenological method.Results: Analysis revealed a four-stage pre-surgical journey. First, patients initially normalized excessive hand sweating as a personal difference or familial trait, but gradually developed disease awareness as symptoms persisted and intensified. Second, PH imposed a substantial psychosocial burden, including functional limitations in study, work, and daily life, as well as reduced self-confidence, anticipatory anxiety, and social avoidance. Many participants described a self-reinforcing “anxiety-sweating” vicious cycle. Third, dissatisfaction with conservative treatments and increasing access to treatment-related information prompted patients to move from temporary coping strategies toward consideration of more durable interventions. Fourth, surgical deliberation was characterized by ambivalence: patients hoped surgery would relieve symptoms and restore social confidence, while also expressing concerns regarding compensatory sweating, postoperative discomfort, and recovery.Conclusion: The pathway toward surgical consideration in patients with palmar hyperhidrosis was a dynamic and ambivalent process shaped by symptom normalization, psychosocial burden, prior treatment experiences, and concerns about surgical risks. These findings highlight the importance of addressing psychological and social experiences alongside technical counseling and support the value of shared decision-making in pre-surgical care.Plain Language Summary: Why was this study done?Palmar hyperhidrosis is a medical condition where people experience excessive sweating on their hands. This creates challenges in daily life and can harm mental well-being. Our study aimed to understand the personal experiences of people living with this condition. We specifically investigated how emotions influence their symptoms and why they eventually decide to undergo surgery.What did the researchers do and find?Our team interviewed 19 adults who have lived with excessive hand sweating for over a decade. Participants described a “vicious cycle” where feeling nervous causes sweating, which then leads to more anxiety.Daily Challenges: Participants reported struggles with tasks like writing, using phone fingerprint scanners, and social interactions like shaking hands.Seeking Help: Many delayed seeking medical help because family members had similar symptoms, leading them to believe the condition was “normal.&#x201DTreatment Choices: Participants found that non-surgical treatments, such as creams or medicines, were often ineffective or uncomfortable This motivated them to choose surgery. However, they felt torn between wanting a cure and fearing side effects, such as compensatory sweating (where sweating stops on the hands but increases on other body parts).What do these results mean?These findings show that excessive hand sweating causes a heavy social and emotional burden, not just physical discomfort. Doctors should provide care that addresses these mental struggles. Offering clear, accurate information about surgical risks and benefits helps people make informed decisions and improves their overall quality of life.Keywords: qualitative study, psychosocial impact, decision-making, quality of life