Perspectives on treatment decision-making across racial groups in adults with degenerative lumbar disease – A pilot study

Introduction

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.

Objectives

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.

Methods

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.

Results

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.”

Conclusion

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.