Page 91 - JSOM Fall 2020

with sooner return to full activity. Collegiate athletes with whether intentions or actual behavior are being measured,
1,2
undiagnosed concussions are at elevated risk of future concus- what counts as disclosure is defined in varying ways across
sions. Early clinical care diminishes the risk of undiagnosed studies. Some ways that lack of disclosure has been operation-
3
catastrophic injury, and limits the potential for additional alized include failing to seek care immediately once symptoms
brain trauma during a window of cerebral vulnerability. In are onset, never seeking care, or playing through potentially
4
addition, early care provides the potential for targeted man- concussive symptoms. 18,19 Finally, determining which statisti-
agement and treatment, thereby reducing the likelihood of cally significant associations are practically meaningful, and
developing persistent postconcussion symptoms. There is no translating them into actionable recommendations for institu-
error-free objective measure of concussion diagnosis. Many tions requires considering local implementation-related con-
5
issues experienced by patients postconcussion are not visible structs such as feasibility and thus involves some subjectivity.
to an external observer. Thus, facilitating early clinical evalu- In light of these limitations to the current literature and the im-
6
ation requires at least some element of symptom self-disclosure portance of considering implementation feasibility, a formal-
by the injured individual (e.g., directly seeking medical care, or ized consensus process using the Delphi method can be a useful
telling a trusted adult or peer about symptoms to facilitate the strategy for developing recommendations. 20–22 Thus, in June
care-seeking process). Despite the benefits of early care seek- 2019, NCAA and Department of Defense convened a meeting
ing, estimates suggest that in some sports more than half of of experts and key stakeholders to use the Delphi method to
adolescent and young adult athletes have continued to play identify feasible and useful recommendations that institutions
while experiencing potential concussive symptoms, with many (athletics departments, military service academy leaders and
suspected concussions never receiving medical attention. 7 the Department of Defense) can implement to increase concus-
sion disclosure. The goal of this report is to describe this con-
The design and implementation of effective efforts to increase sensus process, discuss the resultant recommendations in the
symptom disclosure have not yet been comprehensively ad- context of implementation in collegiate athletics and military
dressed through leading consensus documents such as the settings, and identify areas for future research and program
2016 Berlin Consensus Statement on Concussion. Addressing development.
5
this important behavioral health issue and gap in the litera-
ture, the National Collegiate Athletic Association (NCAA) and Methods
Department of Defense established the NCAA- Department of
Defense Mind Matters Research & Education Grand Chal- Sample and Procedure
lenge (Grand Challenge). Collegiate athletes and military The consensus process was guided by the Delphi method, an
Servicemembers are often of similar age and have been iden- unbiased and efficient approach for aggregating opinions of
tified as “at-risk” groups for sustaining concussions, due to content experts and key stakeholders. Participants were at-
21
their participation in activities with elevated risk of contact tendees at the June 2019 Mind Matters Task Force meeting
or collision. In addition, both groups have goal- focused so- and included academic researchers funded by Grand Challenge
8
cial environments that may encourage individuals to “par- grants, individuals who develop and implement concussion-
ticipate through” concussion symptoms. The partnership related policy and programming (e.g., athletic administrators
9
between the NCAA and Department of Defense recognizes across levels of competition in the NCAA, military health
the highly aligned nature of the concussion disclosure-related officials) and stakeholders affected by the recommendations
challenges for these two groups. For both the Research and (e.g., coaches and athletes across levels of competition in
Education Challenge, a Request for Proposals for competitive the NCAA). Mind Matters grant recipients were the eight
grant awards was issued and research teams were selected and Research Challenge teams and the one Education Challenge
funded. Eight proposals were funded under the Research Chal- Team that received continued funding for program develop-
lenge, whose projects ran from 2016 to 2019. Six proposals ment and evaluation. Other stakeholders were recruited using
were funded under the initial Education Challenge, which ran a key informant-led approach: stakeholders from the NCAA
from 2015 to 2016, with one group (Chestnut Hill College) membership were chosen by the representative divisional
receiving continued funding from 2017 to 2019. More detail governance and student-athletes were chosen by the national
about the Research and Education Challenge and funding Student-Athlete Advisory Committee. A list of all panel par-
recipients is available at: http://www.ncaa.org/sport-science ticipants is provided in the online supplement. A two-phase
-institute/topics/mind-matters-challenge. At the conclusion of modification of the Delphi process was used, inclusive of an
the period of funding, the NCAA and Department of Defense exploration and evaluation phase, as described below. This
21
sought to synthesize findings relevant to increasing concussion process was reviewed and classified as exempt by the Univer-
disclosure and inform guidance to member organizations. sity of Washington Institutional Review Board.

Despite a growing body of research on predictors of disclo- Exploration Phase
sure behavior (e.g., see several references 7,10–17 ), literature in
this area is not yet at a stage where a systematic review or Participants in the consensus process attended a meeting
meta-analysis can indicate clear steps forward for collegiate hosted by the NCAA and Department of Defense in June of
athletic departments, service academies, or the Department 2019. In preparation for this meeting, the nine grant funded
of Defense. One key reason is predictor variables are incon- research teams shared presentations of the core findings of
sistently operationalized and measured. A second key reason their research program related to understanding and increas-
is most studies in this area lack a behavioral outcome, with ing concussion disclosure among athletes and/or military
behavioral intentions often used as a proxy for behavior. In Servicemembers. Copies of each presentation were made avail-
7
the few studies that have prospectively measured disclosure in- able prior to the meeting for participant reference and review,
tentions and behavior, the association is statistically significant and attendees also were provided with the 21 peer-reviewed
but explains less than half of the variance in behavior. Third, published papers resultant from the Grand Challenge-funded
18
Concussion Education From NCAA-Department of Defense | 89