Understanding Barriers to Surgical Care: A Qualitative Study of Black Individuals With Hand Dysfunction

OBJECTIVE: To identify barriers influencing treatment decision-making among Black individuals with carpal tunnel syndrome and to explore mechanisms contributing to disparities in hand surgery utilisation. SUMMARY BACKGROUND DATA: Racial disparities exist in a variety of surgical subspecialties, including hand surgery. Little information on why these disparities exist or how to improve disparities from the patient's perspective is known. METHODS: We conducted a study utilising virtual semi-structured interviews, focusing on participants' interactions with healthcare providers, the impact of hand dysfunction, and participants' experiences with racism and discrimination. Using an interpretive description approach, we captured major themes in the coded data. RESULTS: The sample included 28 Black individuals with carpal tunnel syndrome. We identified three key themes: (1) Racism predisposes Black participants to inequitable care: participants experienced intergenerational drag, microaggressions, discrimination, and mistrust related to historical injustices. Participants engaged in code-switching to navigate biases and have their symptoms validated. (2) Social and systemic factors enable access to care: participants experienced economic instability, limited paid leave, unreliable transportation, inequitable workplace policies, and lack of social support. (3) Inadequate assessment of needs and access to care among Black participants: Participants struggled to navigate the referral process and obtain timely diagnostic testing. Many participants also described how providers misinterpreted their symptoms, which strained relationships with providers. CONCLUSIONS: Racism and discrimination contribute to Black individuals' reluctance to undergo hand surgery. Improving disparities in surgery requires systemic and interpersonal solutions that optimise resource allocation, improve the surgical referral process, mitigate bias in healthcare interactions, and strengthen patient support networks. Understanding the drivers of racial disparities from patients' perspectives is necessary to develop actionable, patient-centred solutions. PATIENT OR PUBLIC CONTRIBUTION: Prior to study initiation, three structured community engagement sessions were conducted to collaborate with Black community members to co-develop and iteratively shape our research question and study design. Our community research collaborators assessed study relevance, refined key study objectives, and informed interview guide domains.