Risk tolerance and eligibility decision-making strategies among young competitive athletes: novel insights into the emerging practice of shared decision making.
Risk tolerance and eligibility decision-making strategies among young competitive athletes: novel insights into the emerging practice of shared decision making.
复制标题
年轻竞技运动员的风险承受能力和资格决策策略：对共同决策新兴实践的新见解。
DOI：
10.1093/eurjpc/zwad250
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发表时间：
2024
影响因子：
8.3
通讯作者：
Baggish,AaronL
中科院分区：
文献类型：
--
作者：
Churchill,TimothyW;O'Kelly,AnnaC;Montembeau,SarahC;Kim,JonathanH;Guseh,JamesS;Wasfy,MeaganM;Dickert,NealW;Baggish,AaronL
最近欧洲和美国关于心血管疾病（CVD）运动员运动资格的指南支持一个以个性化、以患者为中心的决策为中心的框架。1,2具体而言，心血管疾病与心源性猝死（SCD）风险相关的临床指南包括2级建议，规定在承认“普遍的不确定性”后，充分了解情况的运动员考虑继续参加是合理的。这种现代方法与先前的建议有很大的不同，以前的建议支持更家长式的决策过程，因此需要临床护理的范式改变。共同决策（SDM）被认为是解决这一需求的有效途径。共享决策是一种协作过程，在此过程中，临床医生、患者和其他相关利益相关者之间形成伙伴关系，将医学知识与患者的价值观和偏好相结合。有效地实施SDM既需要对风险承受能力进行评估（即个体患者在参加运动期间愿意接受多大的风险），也需要识别SDM过程中的关键参与者，这可能最好是通过了解患者重视和优先考虑谁的输入来指导。迄今为止，关于年轻竞技运动员的风险承受能力和他们对谁应该参加SDM的偏好的数据缺乏。经麻省总医院机构审查委员会批准后，我们在一所美国NCAA一级大学的新入学学生运动员中进行了一项调查，检查了20个不同项目的风险承受能力和决策策略（完整列表见在线补充材料，补充）。
Recent European and US guidelines for sports eligibility among athletes with cardiovascular disease (CVD) endorse a framework centred on individualized, patient-centred decision-making. 1, 2 Specifically, clinical guidance for CVD associated with the risk of sudden cardiac death (SCD) includes Class 2 recommendations stipulating that it may be reasonable to consider continued participation for a fully informed athlete after ‘prevalent uncertainties have been acknowledged.’2 This contemporary approach represents a significant deviation from prior recommendations which endorsed a more paternalistic decision-making process, thereby necessitating a paradigm change in clinical care. Shared decision-making (SDM) has been suggested as an effective way to address this need. 3Shared decision-making is a collaborative process in which a partnership is formed between the clinician, the patient, and other relevant stakeholders to integrate medical knowledge with patient values and preferences. Effective implementation of SDM requires both an assessment of risk tolerance (ie how much risk an individual patient is willing to accept during athletic participation) and the identification of key participants in the SDM process which may best be guided by knowledge of whose input the patient values and prioritizes. 4 To date, data examining risk tolerance in young competitive athletes and their preferences about who should participate in SDM are lacking. After approval by the Massachusetts General Hospital Institutional Review Board, we conducted a survey examining risk tolerance and decision-making strategies among newly matriculated student athletes across a total of 20 different sports (full list in Supplementar y material online, Supplement) at an NCAA Division 1 US university.