Duerr Emmy, Rodriguez Emily, Nephtalem Meron, Mensah Emmanuel, Duffy John R, Cha Thomas, Aidlen Jessica, Tannoury Chadi, Perloff Michael D, Ladin Keren, Hao David, Williamson Theresa
Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Boston University, Boston, MA, USA.
Interv Pain Med. 2025 Jun 3;4(2):100596. doi: 10.1016/j.inpm.2025.100596. eCollection 2025 Jun.
Degenerative lumbar spine disease significantly impairs quality of life, yet racial and socioeconomic disparities in surgical treatment persist, particularly among BIPOC (Black, Indigenous, and Persons of Color) patients, who often experience worse outcomes and are less likely to undergo surgery despite similar or higher pain levels.
This study explored factors that influence treatment decisions among BIPOC and Non-Hispanic White (NHW) patients with degenerative lumbar spine disease, with a focus on understanding how these factors may contribute to disparities in surgical care utilization.
An explorative qualitative study was conducted using semi-structured interviews with 20 patients (10 BIPOC, 10 NHW) considering lumbar spine surgery for spinal stenosis or disc herniation at three major academic institutions in Massachusetts. Thematic analysis identified key themes related to emotional suffering, financial concerns, support systems, and familiarity with spine surgery.
BIPOC patients expressed greater anxiety about surgery, often shaped by prior negative healthcare experiences and broader systemic mistrust. Financial and occupational concerns were more significant for BIPOC patients, who frequently prioritized employment over symptom relief. In contrast, NHW patients more often cited quality-of-life goals as their primary motivator. While perception of support systems were comparable between the groups, emotional suffering was universally reported emotional suffering, with participants using terms such as "miserable," "scared," "embarrassed," and "ashamed."
Emotional, financial, and trust-related differences shape surgical decision-making among racially and ethnically diverse patients with lumbar spine disease. Incorporating culturally responsive communication strategies and decision aids that address patients fears, values, and social contexts may enhance shared decision-making and promote more equitable access to spine surgery.
退行性腰椎疾病严重影响生活质量，但手术治疗中的种族和社会经济差异依然存在，尤其是在黑人、原住民和有色人种（BIPOC）患者中，尽管他们疼痛程度相似或更高，但往往预后更差，接受手术的可能性更小。
本研究探讨了影响患有退行性腰椎疾病的BIPOC和非西班牙裔白人（NHW）患者治疗决策的因素，重点是了解这些因素如何导致手术治疗利用方面的差异。
在马萨诸塞州的三家主要学术机构，对20名考虑因椎管狭窄或椎间盘突出进行腰椎手术的患者（10名BIPOC患者，10名NHW患者）进行了半结构化访谈，开展了一项探索性定性研究。主题分析确定了与情感痛苦、经济担忧、支持系统以及对脊柱手术的熟悉程度相关的关键主题。
BIPOC患者对手术表现出更大的焦虑，这通常受到既往负面医疗经历和更广泛的系统性不信任的影响。经济和职业担忧对BIPOC患者更为显著，他们常常将就业置于症状缓解之上。相比之下，NHW患者更常将生活质量目标作为主要动机。虽然两组对支持系统的认知相当，但普遍报告了情感痛苦，参与者使用了“痛苦”“害怕”“尴尬”和“羞愧”等词汇。
情感、经济和信任相关的差异影响了不同种族和族裔的腰椎疾病患者的手术决策。采用具有文化敏感性的沟通策略和决策辅助工具，解决患者的恐惧、价值观和社会背景问题，可能会加强共同决策，并促进更公平地获得脊柱手术治疗。
