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What Do Parents Need to Know About Concussion? Developing Consensus Using the Delphi Method

Kroshus, Emily, ScD*,†,‡; Chrisman, Sara P. D., MD*,†,‡; Harmon, Kimberly G., MD§,¶; Herring, Stanley A., MD¶,║,**; Broglio, Steven P., PhD††,‡‡,§§; Master, Christina L., MD¶¶; McGill, Catherine A., PsyD║║,***; Putukian, Margot, MD†††; Register-Mihalik, Johna K., PhD‡‡‡; Rivara, Frederick P., MD*,†,‡ for the National Delphi Panel on Sports Concussion Knowledge

doi: 10.1097/JSM.0000000000000702
Original Research: PDF Only

Objective: Many schools and sports leagues provide preseason concussion education to parents/guardians, and in some jurisdictions, it is required for interscholastic sports participation. However, directives about content are absent or vague. The purpose of this study was to obtain expert consensus about what parents/guardians need to know to about concussion.

Design: A modified Delphi process with nationally recognized expert panel members was used to obtain consensus about parent/guardian behaviors relevant to concussion prevention, identification, and management and knowledge domains relevant to performance of those behaviors.

Results: Sixteen parent/guardian behaviors and 24 knowledge domains were identified. However, consensus was not achieved regarding whether it is realistic to expect parents/guardians to perform approximately one-third of the behaviors that experts agreed mattered. This variability may reflect underlying uncertainty about the capacities of some parents/guardians to put knowledge into action or the belief that there are other barriers to action. Furthermore, for most knowledge domains, there was a lack of agreement about whether or not there could be a “correct” answer on the basis of current scientific knowledge.

Conclusions: These findings raise practical and ethical questions: how can we expect parents/guardians to help prevent, identify, or manage concussion if they cannot have all the information required to engage in these behaviors due to lack of scientific consensus? This issue is not unique to concussion. Best practices for risk communication and shared decision-making can inform how we think about educating parents/guardians about concussion inside and outside of the health care setting.

*Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington;

Department of Pediatrics, University of Washington, Seattle, Washington;

Harborview Injury Prevention and Research Center, Seattle, Washington;

Departments of §Family Medicine;

Orthopaedics and Sports Medicine;

Neurological Surgery; and

**Rehabilitation Medicine, University of Washington, Seattle, Washington;

††School of Kinesiology, University of Michigan, Ann Arbor, Michigan;

Departments of ‡‡Neurology; and

§§Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan;

¶¶Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania;

║║The George Washington University School of Medicine, Washington, District of Columbia;

***Children's National Health System, Washington, District of Columbia;

†††Princeton University, Princeton, New Jersey; and

‡‡‡Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

Corresponding Author: Emily Kroshus, ScD, Department of Pediatrics, University of Washington, 2001 8th Ave, Ste 400, Seattle WA 98121 (

The authors report no conflicts of interest.

Received August 01, 2017

Accepted October 13, 2018

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