# Developing a tool to support shared decision making post-concussion between adolescents, parents and clinicians

> **NIH NIH R21** · SEATTLE CHILDREN'S HOSPITAL · 2021 · $198,752

## Abstract

PROJECT SUMMARY
Every year, more than one million U.S. youth sport participants ages 6 to 18 are diagnosed with a concussion.
After acute post-concussive symptoms have resolved, clinicians often struggle with how to discuss returning to
sport with families. The decision to cease sport is very individualized and cannot be reduced to a single
numeric cut-off. Influential factors in this decision include clinical variability (e.g., injury severity, recovery
trajectory, type of functional impairment post-injury, the interval between prior injuries, the age at which injuries
occurred, and premorbid health conditions), different family tolerance for the uncertain risk of harm associated
with sustaining an additional concussion relative to what they see as the benefits of returning to sport, the risks
and benefits of substitute activities, and psychosocial readiness for sport retirement. Further complicating this
conversation is the lack of definitive evidence about about the potential long-term risks of contact sport and the
incremental increase in risk with subsequent concussions among youth. Addressing these challenges, we seek
to develop and evaluate a decision aid that helps adolescents and their parents/guardians with their clinician
make an informed and value-driven decision about sport participation post-concussion. We will focus on
helping shared decision making in two situations: (1) the clinician believes there is equipoise in the decision
about whether to return to or cease participation in contact/collision sport, and (2) the clinician believes
contact/collision sport cessation would be medically beneficial but sport disqualification is not mandatory based
on current consensus guidelines. This will be accomplished with a (1) a web-based module to be completed
separately by parents and adolescents pre-visit, sharing risk information and supporting values clarification
related to sport participation, and (2) implementation support for clinicians to facilitate within -visit discussion,
prioritization and decision-making. To develop an optimally useful decision aid, we will engage a diverse group
of families and clinicians in the development process and will focus on meeting the needs of families with low
health literacy. Thus, the following aims will be addressed: (1) Develop a decision aid to support shared
decision-making about sport participation post-concussion using a process of user-engaged content
specification and design; (2) Conduct usability testing of the decision aid in a clinical setting; (3) Conduct a pilot
test of the efficacy of this decision aid in a diverse sample of families presenting to Seattle Children’s Hospital
for post-concussion care. The primary outcome of the pilot clinical trial will be decisional regret. Secondarily,
the impact of the tool on sport participation, physical activity and psychosocial outcomes three months post-
decision will be explored. Achieving the proposed aims will result in a decision aid that ...

## Key facts

- **NIH application ID:** 10135128
- **Project number:** 5R21HD098355-02
- **Recipient organization:** SEATTLE CHILDREN'S HOSPITAL
- **Principal Investigator:** Emily Grace Kroshus
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $198,752
- **Award type:** 5
- **Project period:** 2020-04-01 → 2024-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10135128

## Citation

> US National Institutes of Health, RePORTER application 10135128, Developing a tool to support shared decision making post-concussion between adolescents, parents and clinicians (5R21HD098355-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10135128. Licensed CC0.

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