A Qualitative Study of Surgical Hesitancy Among Chinese Americans Compared to Hispanic Americans with Chronic Rhinosinusitis

Background and Purpose:
Chronic rhinosinusitis (CRS) profoundly affects quality of life, often requiring decisions about endoscopic sinus surgery (ESS) when medical treatments fail. Yet, disparities in ESS uptake persist among racial and ethnic minorities, including Chinese and Hispanic Americans, reflecting broader healthcare inequities. These gaps may stem from cultural, social, and systemic factors, but little is known about how these groups navigate surgical choices. Social workers are critical in advancing health equity by addressing such disparities. This qualitative study explores decision-making processes and concerns among Chinese and Hispanic American patients with CRS, aiming to uncover cultural and access-related influences to inform equitable, culturally sensitive care.

Methods:
This study recruited 35 Chinese and Hispanic American patients with medically refractory CRS and eligible for ESS from distinct settings in metropolitan Los Angeles. Chinese Americans were drawn from an academic outpatient otolaryngology clinic, while Hispanic Americans were recruited from a safety-net hospital’s otolaryngology department. Semi-structured interviews, conducted in participants’ preferred languages (Mandarin, English, or Spanish), explored CRS symptoms, healthcare-seeking behaviors, patient-physician dynamics, and factors shaping ESS decisions, including cultural beliefs and access barriers. Audio-recorded interviews were transcribed, translated into English when necessary, and analyzed using thematic analysis with Dedoose software to compare decision-making patterns and their equity implications.

Results:
Participants (mean age 52.7 years, 51.4% female, 27.38 years average U.S. residency, 64.1% college-educated) revealed divergent decision-making patterns. Chinese Americans (n=18) showed three profiles: optimistic and proactive, hesitant and uncertain, and reluctant and risk-averse. Optimistic patients viewed ESS as health-improving, while hesitant ones wavered over risks, recovery, and regret. Reluctant patients, influenced by cultural preferences for non-invasive approaches, avoided surgery unless critical. Barriers included fears of complications and distrust in surgical benefits, signaling unmet needs for tailored support. Hispanic Americans (n=17), enduring longer wait times for ESS, were more proactive, driven by severe symptom burden and urgency for relief. Their trust in divine guidance for surgical success and family-centric values outweighed recovery concerns, emphasizing their desire to restore health for familial roles.

Conclusions and Implications:
This study advances health equity by illuminating disparities in ESS decision-making. Chinese Americans, from an academic outpatient otolaryngology clinic, displayed hesitancy rooted in risk aversion and cultural preferences, necessitating culturally sensitive counseling to bridge trust gaps. Hispanic Americans, from a safety-net hospital’s otolaryngology department, showed urgency for ESS due to prolonged waits and debilitating symptoms, bolstered by faith and family values, suggesting opportunities to reinforce shared decision-making while addressing access delays. These findings highlight how cultural, systemic, and access-related factors shape surgical uptake, perpetuating inequities. Social workers and clinicians can reduce disparities by offering targeted interventions—culturally competent support for Chinese patients and expedited care for Hispanic patients—enhancing satisfaction and outcomes, and fostering a more equitable healthcare system for CRS patients across diverse settings.