Page 92 - JSOM Fall 2020

projects to date. Opportunities for group discussion about components of statement revisions were determined. After this
these findings were provided. in-person meeting, a small working group (led by the lead au-
thor along with representatives with expertise in health educa-
Prior to the meeting, each of the nine research teams provided tion from the NCAA and Department of Defense) synthesized
one or more statements summarizing what they considered the in-person and written comments and feedback to finalize a
to be the most important takeaways from their individual second iteration of recommendation on statements that lacked
projects’ findings as well as the collection of projects that consensus in the first round of voting.
were funded. An internal working group reviewed these 26
statements and noted that there were areas of overlap across Participants were emailed a second survey link containing
groups and that not all statements were worded as actions these updated statements, with voting again anonymous and
that institutions could take to increase concussion disclosure. occurring online. As in the first round, descriptive statistics
Thus, a thematic analysis was conducted and statements were were tabulated and reviewed by the working group, with edits
grouped initially into seven emergent themes (e.g., cognitive made to statements not reaching consensus based on themes
targets of education, multi-level problem, organizational emergent from the open-ended comments. In most cases, feed-
values). Statements within each theme were reviewed and back indicated relatively minor wording changes to make the
23
synthesized/combined where necessary, retaining original recommendations more concrete or inclusive; those changes
terminology where possible, to create 12 provisional recom- were prioritized. The remainder of the consensus process oc-
mendations. The goal of these synthesized recommendations curred asynchronously following the same process. This con-
was to reflect the content of the research group submissions tinued through a total of three rounds of voting, open-ended
while (1) reducing redundancy across groups, and (2) making feedback review and statement editing and included combin-
the recommendations actionable for institutions. The original ing several statements for final dissemination given conceptual
statements, thematic analysis documentation, and provisional overlap. Statements not reaching consensus after two rounds
recommendations were shared with participants. of modification and voting were not included in the final set
of recommendations.
Evaluation Phase
Results and Discussion
At the in-person meeting, participants reviewed the original
statements and provisional recommendations, with the goal of A total of 17 statements met identified thresholds for utility
ensuring that the provisional recommendations were (1) clearly and feasibility after 3 rounds of voting (see Table 1 for a list
worded and (2) reflected the science informing the original of final recommendations and online supplementary Table 1
statements. As a result of this process, edits were made to most for scores found at https://jsom.us/2ZaU8cO). Statements that
statements, and 12 new statements were added, separating were not included in the final set were eliminated because
double barreled concepts within statements so that they could consensus could not be reached on feasibility. The final list of
be voted upon independently and adding key content that was statements is presented below, separated into five conceptual
not included in the original submitted statements. Participants domains: (1) content of concussion education for athletes and
were then provided with a link to an anonymous online sur- military service academy cadets, (2) dissemination of concus-
vey and asked to indicate the utility and feasibility of each rec- sion education, (3) other stakeholder concussion education,
ommendation. Utility was defined as whether, if implemented, (4) team- and unit-level processes, and (5) organizational pro-
the recommendations would meaningfully improve concussion cesses. Each domain is briefly discussed, with a focus on pro-
disclosure. Feasibility was defined as whether the recommen- viding context for the recommendation and proposing how
dation could reasonably be implemented by institutions (in- the recommendations can be made actionable by institutions.
clusive of collegiate athletic departments of varying resource
levels and military service academies). Consistent with prior Domain 1: Content of concussion education for athletes and
models of Delphi process voting, 20,24 each dimension was rated military Servicemembers
on a 9-point scale, where higher scores indicated greater utility/ Provide athletes/Servicemembers with education that addresses:
feasibility. After each recommendation, participants were pro- • Recommendation 1: The potential dilemma individ-
vided with an open-ended space for comment and encouraged uals face when deciding to disclose a concussion (e.g.,
to describe their rationale if they scored an item 6 or less. tradeoffs, concerns about what might happen next,
knowing how to report, etc.)
Subsequently, the mean and standard deviation for utility and • Recommendation 2: Short-term benefits of early con-
feasibility were calculated for each recommendation. For a rec- cussion symptom disclosure (e.g., athletic, academic,
ommendation to be included in the final set it required mean occupational).
utility and feasibility scores of 7 or more. 24,25 Recommenda- • Recommendation 3: What is known about possible
tions scoring 3 or below were dropped from consideration long-term manifestations of concussion and head injury.
while those with mean scores of 4, 5, or 6 on either dimension • Recommendation 4: Concussion-related misperceptions
were considered to lack consensus and were revisited. Partic- (e.g., knowledge gaps).
ipants met in person and were provided with the mean scores • Recommendation 5: Site-specific information regard-
for each item, and aggregated open-ended feedback. For each ing institutional concussion resources and policies
recommendation lacking consensus participants worked in (e.g., steps to take if an individual suspects they have a
small groups to review the aggregated open-ended feedback, concussion).
to identify emergent themes to be addressed and to generate
potential wording modifications to statements. A facilitated There was agreement about the importance of addressing the
full-group discussion about each statement followed, during disclosure decision explicitly, acknowledging the individual
which small group discussion points were shared and core will be considering the tradeoffs between potential benefits

90 | JSOM Volume 20, Edition 3 / Fall 2020