Decision-Making and Hesitancy in Elective Surgery: Exploring the Chinese American Experience with Chronic Rhinosinusitis

Background and Purpose:
Social workers are integral in addressing healthcare disparities, especially those rooted in racial and ethnic differences. Elective surgeries like endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) present unique challenges at the intersection of health and social care. Notably, Chinese Americans, among other minorities in the U.S., show lower uptake rates for ESS despite its effectiveness and availability, underscoring potential disparities in decision-making processes. This qualitative study focuses on understanding the factors influencing ESS decisions among Chinese American patients, aiming to identify cultural and personal themes impacting their treatment choices.

Methods:
Qualitative interviews were conducted with 22 Chinese American patients who have medically refractory CRS, selected from four otolaryngology clinics in Los Angeles. Participants were presented with a choice between continued medical management and ESS. The semi-structured interviews explored their symptoms, additional health conditions, healthcare-seeking behaviors, patient-physician dynamics, and personal thoughts influencing their decision-making. Interview transcripts were analyzed using Dedoose software to identify recurring patterns and themes specific to this cultural group.

Results:
The patients, averaging 53.1 years of age, with a near-equal gender distribution and most speaking Mandarin as their primary language, greatly valued the shared decision-making approach in their healthcare management. The analysis identified three predominant decision-making patterns:

1. Optimistic and proactive: Patients in this category were prepared to undergo ESS, viewing it as a beneficial step towards improved health. They acknowledged surgical risks but felt the potential benefits of symptom relief and enhanced quality of life were worth these risks.
2. Hesitant and uncertain: These patients were indecisive about opting for ESS, often due to concerns about surgical risks, the recovery process, and potential unsatisfactory outcomes. They expressed a need for more information and better communication with healthcare providers, suggesting that enhanced support could bolster their decision confidence.
3. Reluctant and risk-averse: Influenced by personal beliefs, fear of surgical complications, or a belief in managing their condition non-surgically, these patients were generally opposed to surgery, viewing it as a last resort only under dire circumstances.

Key themes driving surgical hesitancy included concerns about coexisting health conditions, apprehensions about post-operative recovery, potential surgical risks, fear of regret if outcomes were not favorable, doubts about the long-term benefits of surgery, and a preference for non-surgical management unless absolutely necessary.

Conclusions and Implications:
The decision-making process for Chinese American patients with CRS considering ESS is complex and influenced by multiple layers of cultural and personal factors. Social workers need to adopt a culturally sensitive approach that respects individual values and preferences, helping to navigate these decisions. This study highlights the critical role of social workers in facilitating culturally competent communication and advocating for shared decision-making in healthcare settings. By ensuring that patient voices are respected and cultural nuances are integrated into care planning, social workers can help improve treatment outcomes and patient satisfaction in managing CRS.