Coaches, practitioners, and organizational leaders make decisions about preparation, competition, rehabilitation, athlete availability, and resource allocation throughout high-performance sport. In a comprehensive narrative review published in Sports Medicine – Open, researchers have synthesized literature across sports science, medicine, organizational leadership, and decision theory to introduce a conceptual framework for integrated decision-making under uncertainty. The authors emphasize that greater expertise, more data, and increased collaboration do not necessarily improve decisions in high-performance sport. Instead, the review notes that decision processes are bounded by cognitive capacity and that expanding services without adequate coordination can increase fragmentation, duplicated work, or contradictory messages. To address these operational hazards, the authors propose a structured pathway that couples systematic decision triage with five interdependent operating functions, establishing a formal architecture to connect empirical evidence and professional clinical judgement directly to transparent, accountable action.
Although support systems draw on multiple disciplines because preparation and performance involve interacting biological, psychological, technical, tactical, social, and organizational factors, expanding services without coordination presents operational difficulties. Adding expertise without adequate coordination can increase fragmentation, duplicated work, or contradictory messages, while tensions around professional identity and power can challenge collective work. Decisions in elite sport must often be made under time pressure and with incomplete information, selecting or adapting a course of action when outcomes cannot be known with confidence. Under such conditions, poorly specified collaboration can add delay, meeting burden, and ambiguity about responsibility, demonstrating that connecting expertise requires clear professional responsibilities and communication.
To build a conceptual foundation for structured decision support, the authors conducted an iterative narrative synthesis of peer-reviewed and applied literature across five key disciplinary domains: performance support structures, team functioning and collaboration, leadership and governance, sport science decision support, and decision-making under uncertainty. Targeted database searches were conducted across Scopus, Web of Science Core Collection, SPORTDiscus, and PubMed, with the literature retrieval concluded in June 2026. The search strategy combined sport-related terms with decision-science concepts including bounded rationality, computational complexity, dual-process, naturalistic decision-making, risk, decision analysis, and shared decision-making. Selected sources spanned empirical sport investigations, team-science research, and conceptual healthcare models, which were subsequently mapped against recurring operational checkpoints such as problem framing, participant selection, authority allocation, option generation, implementation, and retrospective review, without conducting a formal quantitative meta-analysis or certainty assessment.
At the center of the proposed framework sits a qualitative triage model designed to select the least burdensome working mode capable of resolving a given problem safely and effectively. Rather than assuming that every athletic concern warrants collective team deliberation, the triage mechanism evaluates six explicit situational dimensions: temporal urgency, informational uncertainty, risk and severity of potential adverse consequences, reversibility of the prospective commitment, interdisciplinary interdependence of the required contributions, and the presence of differing stakeholder perspectives or risk tolerances. Urgency sets the available time, shaping whether decisions use brief huddles, direct conversations, or asynchronous input, while low reversibility strengthens the case for scrutiny before commitment. By analyzing these interacting dimensions qualitatively rather than relying on an artificial numerical score, designated leaders can determine whether an emerging issue warrants solo professional execution or expanded interdisciplinary collaboration.
The triage protocol formally differentiates between three primary operational pathways: discipline-led decisions, consultation or coordinated input, and fully integrated collective decision-making. Discipline-led work is appropriate when the problem is bounded, expertise and authority sit within the relevant professional domain, and consequences can be managed within that scope. Multidisciplinary consultation is triggered when the primary objective is clear but requires specific advisory input from an adjacent domain, allowing specialists to contribute discrete insights without undergoing an extensive, time-consuming reframing of the underlying problem. By contrast, fully integrated decision-making is selectively deployed only when complex, interdependent trade-offs arise, such as cases where medical clearance, physiological training tolerances, and coaching game plans cannot be resolved independently, thereby preventing excessive meeting demands while safeguarding collaborative scrutiny for truly critical choices.
To prevent collaborative ambiguity from eroding accountability, the framework establishes a rigorous system of governance that formally separates four distinct operational responsibilities across participating personnel. These four defined roles comprise information provision, recommendation development, final decision authority, and tactical implementation responsibility. Within this structure, the medical department retains responsibility for clinical diagnosis, health-risk assessment, and health-information governance. Coaches contribute training, technical, tactical, and competitive knowledge, commonly determining how recommendations are implemented, while organizational leaders coordinate resource commitments.
A critical pillar of the authors’ proposal is the explicit incorporation of athlete voice, legal autonomy, and shared decision-making into institutional workflows. The framework emphasizes that athlete values and decision rights should shape relevant choices, particularly for preference-sensitive decisions concerning health, treatment, or participation. In such scenarios, shared decision-making involves discussing options, benefits, harms, and uncertainty in understandable terms, allowing the athlete's goals and risk preferences to shape deliberation. The review clarifies that autonomy does not entitle an athlete to demand clinical clearance or selection, nor does professional authority justify overriding a valid refusal of consent-dependent treatment.
When an issue demands selective integration, the framework organizes collaborative effort through five interdependent, non-linear functions supported by scientific reasoning and integrative leadership. The first function focuses on framing the problem and decision, stating what must be understood, what must be decided, and by when, while identifying constraints and questions for inquiry. The second function identifies necessary contributors and confirms governance rights, explicitly defining who holds authority and who manages implementation. The third function centers on synthesizing evidence, sensor metrics, and clinical observations to generate a manageable set of viable options while making underlying trade-offs and remaining uncertainties explicit. The fourth function involves committing to and communicating a course of action, recording material dissent alongside the rationale, and verifying understanding and feasibility before action. Finally, the fifth function directs acting, monitoring, and learning, specifying what will be monitored, when review will occur, and what would justify adaptation or discontinuation.
The authors contextualize the application of their conceptual model through three distinct hypothetical case studies: return-to-sport clearance following recurrent hamstring injury, acute morning training modification, and institutional technology adoption. In the return-to-sport scenario, an athlete returning from a hamstring injury involves interdependent clinical assessments, exposure demands, tactical needs, and athlete goals, resolved through integrated discussion and shared decision-making. In the training modification scenario, lower-than-usual readiness and fatigue on the morning of a session are addressed through a brief integrated discussion that avoids treating a readiness measure as an automated decision rule. In the technology adoption scenario, an organization contemplating a monitoring technology evaluates measurement quality, evidence, usability, and governance through a time-bounded pilot before wider adoption.
Despite its structured operational logic, the review explicitly underscores that the proposed framework remains a theoretical, conceptual contribution that has not yet undergone rigorous empirical validation. The authors emphasize that the framework remains conceptual and that outcomes alone are insufficient to judge decision quality, as a defensible process may precede an adverse result while a weak process may precede success. Consequently, initial evaluation should examine content validity, usability, triage consistency, implementation burden, and decision processes before assessing health and performance effects. Only after staged evaluation of process outcomes should subsequent studies examine effects on athlete health, availability, performance, and organizational learning.
Subject of Research: Conceptual framework for integrated decision-making under uncertainty in elite sport support systems
Article Title: Integrated Decision-Making Under Uncertainty in High-Performance Sport Support Systems
Article References: Rebelo, A., King, R., Valente-dos-Santos, J., & Thorpe, R. T. (2026). Integrated Decision-Making Under Uncertainty in High-Performance Sport Support Systems. Sports Medicine – Open, 12(1), Article 175. https://doi.org/10.1186/s40798-026-01149-z
Image Credits: AI Generated
DOI: 10.1186/s40798-026-01149-z
Keywords: high-performance sport, decision-making under uncertainty, sports medicine, sport science, interdisciplinary practice, decision triage, integrative leadership, athlete autonomy, shared decision-making, team functioning, performance support, organizational governance, applied inquiry, return to sport, training modification, technology adoption, risk appraisal, process evaluation
News Source: Ophelia Keating. (November 12, 2026). Scientists Propose Structured Framework to Improve High-Performance Sport Decision-Making Under Uncertainty. Scienmag.
