Understanding Decision Making by Families About Youth Football Participation Postconcussion

Many families are concerned about their child's risk of concussion, and some seek counsel from clinicians about whether or not to return to contact sports participation postinjury. The present study sought to identify factors that parents weight most heavily in forming their preferences regarding whether their child should return to contact sport after recovering from a concussion. Survey data were collected from 568 parents of youth football players (aged 7-14 years) in the Pacific Northwest region of the United States (73% response rate). Approximately two thirds (63%) of parents preferred that their child retire from football after one or two concussions. Multivariable linear regression indicated parents above the sample mean in terms of how strongly they valued football participation preferred their child stop after more concussions than parents below the sample mean (β = .44, standard error [SE] = 0.06, p < .001). Factors endorsed by the most parents as making them "much more likely" to want their child to stop playing football included the belief that their child will experience cognitive issues later in life as a result of concussions (65.0%) and that their child will get another concussion while playing football (43.5%). Within the context of a clinical visit postconcussion, physicians may need to help families clarify their values related to football participation and provide information about the potential outcomes of returning to contact sport. A formalized shared decision aid could help support consistent implementation of this potentially challenging conversation.