Early disclosure of possible concussive symptoms has the potential to improve concussion-related clinical outcomes. The objective of the present consensus process was to provide useful and feasible recommendations for collegiate athletic departments and military service academy leaders about how to increase concussion symptom disclosure in their setting. Consensus was obtained using a modified Delphi process. Participants in the consensus process were grant awardees from the National Collegiate Athletic Association and Department of Defense Mind Matters Research & Education Grand Challenge and a multidisciplinary group of stakeholders from collegiate athletics and military service academies. The process included a combination of in-person meetings and anonymous online voting on iteratively modified recommendations for approaches to improve concussion symptom disclosure. Recommendations were rated in terms of their utility and feasibility in collegiate athletic and military service academy settings with a priori thresholds for retaining, discarding and revising statements. A total of 17 recommendations met thresholds for utility and feasibility and are grouped for discussion in five domains: (1) content of concussion education for athletes and military service academy cadets, (2) dissemination and implementation of concussion education for athletes and military service academy cadets, (3) other stakeholder concussion education, (4) team and unit-level processes and (5) organisational processes. Collectively, these recommendations provide a path forward for athletics departments and military service academies in terms of the behavioural health supports and institutional processes that are needed to increase early and honest disclosure of concussion symptoms and ultimately to improve clinical care outcomes.
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Presented at This article has been co-published in the British Journal of Sports Medicine and the Journal of Special Operations Medicine.
Contributors All authors have made substantial contributions to either conception and design or analysis and interpretation of data, drafting or revision of the article, and have seen and given final approval of the submission.
Funding This publication was made possible, in part, with support from the NCAA-DoD Grand Alliance Mind Matters Challenge, funded, in part by the National Collegiate Athletic Association and the Department of Defense.
Disclaimer Opinions, interpretations, conclusions and recommendations are those of the authors and are not necessarily endorsed by the Department of Defense.
Competing interests EK reports funding from the National Collegiate Athletic Association during the conduct of the study and research funding to institution in past 3 years from the Pac-12 Athletic Conference. KC reports grants from National Collegiate Athletic Association and US Department of Defense during the conduct of the study, book royalties from Springer, and membership on the NATA Foundation Board of Directors. JDS reports grants from National Collegiate Athletic Association and US Department of Defense during the conduct of the study. CD’L reports grants from the National Collegiate Athletic Association and US Department of Defense during the conduct of the study. JKR-M reports grants from the National Collegiate Athletic Association and US Department of Defense during the conduct of the study, research funding to institution in past 3 years from: National Football League, National Athletic Trainers Association Foundation, Centers for Disease Control, National Operating Committee on Standards for Athletic Equipment, and current membership on USA Football's Football Development Council. RS reports funding from the National Collegiate Athletic Association during conduct of the study.
Patient consent for publication Not required.
Ethics approval University of Washington Institutional Review Board.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon request