Social and Behavioral Implications of National Collegiate Athletic Association Sickle Cell Trait Screening: The Athletes’ Perspective

Background: In August 2010, the National Collegiate Athletic Association (NCAA) implemented a policy mandating sickle cell trait (SCT) testing for all Division I collegiate athletes. Subsequently, all Division II-III athletes were also compelled to undergo SCT testing. This decision has met with controversy among healthcare providers, researchers, and sickle cell advocates. However, there is little information concerning the athletes’ perspective of this policy. The purpose of this paper is to report the findings of a qualitative study that explored college athletes’ perceptions of sickle cell trait SCT, NCAA policies on SCT testing, and potential implications of SCT screening. Methods: The participants were eighteen male and female athletes (ages 18-24), members of NCAA-governed teams who were on the study campus from April-August 2010. Athletes participated in focus groups that gathered their perceptions of the SCT, the NCAA SCT policy, and social and behavioral implications of a SCT diagnosis. Results: Athletes lacked knowledge of the SCT and the implications of a positive screening test result, desired health education about SCT, were conflicted about sharing health information, and feared loss of playing time if found to carry the SCT. Conclusions: The study revealed athletes’ perceptions of the SCT and mandated NCAA SCT testing that should be addressed by college health professionals

Social and Behavioral Implications of National Collegiate Athletic Association Sickle Cell Trait Screening: The Athletes\u27 Perspective

Background: In August 2010, the National Collegiate Athletic Association (NCAA) implemented a policy mandating sickle cell trait (SCT) testing for all Division I collegiate athletes. Subsequently, all Division II-III athletes were also compelled to undergo SCT testing. This decision has met with controversy among healthcare providers, researchers, and sickle cell advocates. However, there is little information concerning the athletes’ perspective of this policy. The purpose of this paper is to report the findings of a qualitative study that explored college athletes’ perceptions of sickle cell trait SCT, NCAA policies on SCT testing, and potential implications of SCT screening. Methods: The participants were eighteen male and female athletes (ages 18-24), members of NCAA-governed teams who were on the study campus from April-August 2010. Athletes participated in focus groups that gathered their perceptions of the SCT, the NCAA SCT policy, and social and behavioral implications of a SCT diagnosis. Results: Athletes lacked knowledge of the SCT and the implications of a positive screening test result, desired health education about SCT, were conflicted about sharing health information, and feared loss of playing time if found to carry the SCT. Conclusions: The study revealed athletes’ perceptions of the SCT and mandated NCAA SCT testing that should be addressed by college health professionals

What does shared decision making look like in natural settings? A mixed methods study of patient–provider conversations

Objective: To understand the variability and nature of shared decision making (SDM) regarding a uniform type of serious medical decision, and to make normative judgments about how these conversations might be improved. Methods: This was a mixed-methods sub-analysis of the Improving Patient Outcomes with Respect and Trust (IMPORT) study. We used the Braddock framework to identify and describe seven elements of SDM in audio-recorded encounters regarding initiation of hydroxyurea, and used data from medical records and patient questionnaires to understand whether and how these tasks were achieved. Results: Physicians covered a spectrum of SDM behaviors: all dialogues contained discussion regarding the clinical issue and the pros and cons of treatment; the patient's understanding and role were not explicitly assessed or stated in any encounter. Yet no patient agreed to start hydroxyurea who did not already prefer it. There was no uniform approach to how physicians presented risk; many concerns expressed by patients in a pre-visit questionnaire were not discussed. Conclusion: In this analysis, patients seemed to understand their role in the decision-making process, suggesting that a patient's role may not always need to be explicitly stated. However, shared decision making might be improved with more routine assessment of patient understanding and concerns. Standardized decision aids might help fully inform patients of risks and benefits