Making confident return-to-play decisions is one of the most difficult parts of an athletic trainer’s (AT’s) job.
Facing pressure from coaches, administration, parents, fans and even the injured player, ATs have mere minutes to assess the severity of an athlete’s injury and decide whether the player should return to the game. Though the AT is most concerned with the safety of the player, others are worried more about the scoreboard.
How can athletic trainers keep the well-being of the athlete at the forefront (or maintain athlete-centered care) while facing outside pressures? Here are three ways ATs can find the balance between the best interests of the player and the wants of coaches and administration.
Take a Collaborative Approach to Decisions
Athlete-centered care applies the principles of the patient-centered care model to sports medicine and athletic training practices. Whereas the traditional approach to athletic care relies almost exclusively on evaluating only the injury itself, athlete-centered care takes into account the individual player’s needs and preferences when determining treatment decisions. It is characterized by open communication between the AT and the player and places an emphasis on the responsibility of the AT to educate and involve the athlete in decisions regarding his or her health.
A critical aspect of athlete-centered care is shared decision making. Shared decision making is a collaborative process where ATs and players work together to make the best decisions. In the shared decision-making process, the AT’s responsibility is to provide their knowledge and expertise, and the athlete’s role is to communicate his or her needs and goals.
Support Player Autonomy
In all aspects of health care, one of the fundamental principles is respecting the patient’s autonomy. In athlete-centered care, ATs can support a player’s capacity to make autonomous choices by providing all appropriate facts the player needs to make an informed decision about their care. This includes risks and benefits of the AT’s recommended course of action as well as information about any alternative treatments the athlete may choose. By empowering athletes to take a more active role in their return-to-play decision, ATs can encourage players to be more objective in their judgment.
However, ATs must recognize encouraging athletes to be autonomous does not mean allowing the player to do whatever they want to do. ATs should acknowledge and respect the player’s wishes, but they are under no obligation to fulfill these wishes if they feel the player’s health would be at risk. A player’s desire to return to the field may cloud their judgment, which means they cannot be expected to make a truly unbiased assessment of their options. Thus, the AT must take into consideration the player’s opinion but ultimately choose the option that will be in the best interest of the athlete.
Adopt the POPE Principle
In his article, “The Problem of the Sports Doctor: Serving Two (Or Is It Three or Four?) Masters,” Barry Furrow recommends a strategy sports medicine professionals can use to reduce conflicts of interest. He uses the acronym POPE to summarize the approach:
- P - Protect athletes from injury, re-injury or permanent disability, placing their welfare over that of the team or other competing interests
- O - Offer candid and full disclosure as to the nature and extent of injuries and the consequences of returning to play
- P - Practice good medicine, as defined by practice guidelines and consensus statement
- E - Enable players to avoid unnecessary risks, both by helping them understand what proper treatment is and what risks are presented by returning to play, and by sharpening the framework for a declaration of ineligibility to play under some circumstances, removing the choice from the player as well as the team and coach
The final aspect of the POPE principle is one that ATs and sports medicine professionals may find as the most powerful tool at their disposal. With explicit policies and guidelines addressing the risks of returning to play, ATs can help shield themselves from some of the pressure they face to send players back on the field as quickly as possible.
When making return-to-play decisions, athletic trainers must not only consider the desires of the organization but also the need to abide by the National Athletic Trainers’ Association Code of Ethics as well as their own moral standards. While this is no easy task, using shared decision making, supporting player autonomy and adopting the POPE principle can help ATs build an athletic department focused on maintaining athlete-centered care.