Symposia
Dissemination & Implementation Science
Gabriela K. Khazanov, Ph.D.
Research Psychologist
Corporal Michael J Crescenz VA Medical Center
Philadelphia, Pennsylvania
Shimrit Keddem, PhD
Assistant Professor
Perelman School of Medicine
philadelphia, Pennsylvania
Katelin Hoskins, PhD CNRP
Postdoctoral Fellow
Perelman School of Medicine
Philadelphia, Pennsylvania
Sarah Sullivan, BA
Graduate student
The Graduate Center, City University of New York
New York, New York
Emily L. Mitchell, PhD
Clinical Research Coordinator
James J. Peters VA Medical Center
Bronx, New York
Karoline N. Myhre, M.A.
Clinical Research Coordinator
University of Pennsylvania
Philadelphia, Pennsylvania
Brooke Holliman, PhD
Assistant Professor
University of Colorado School of Medicine
Aurora, Colorado
Sara Landes, Ph.D.
Director, Behavioral Health QUERI
Central Arkansas Veterans Healthcare System
Maumelle, AR
Joseph Simonetti, MD MPHD
Assistant Professor
University of Colorado Anschutz School of Medicine
Aurora, Colorado
Lethal means safety counseling (LMSC), during which providers encourage patients to limit access to lethal means (e.g., firearms, medications), is an evidence-based suicide prevention intervention that is underutilized in clinical practice. We conducted a meta-analysis of qualitative literature published from 1995-2021 to synthesize findings of studies that examined stakeholder-reported barriers to LMSC and described ways to increase patient and provider engagement in this intervention. We searched Pubmed and PsycInfo using search terms related to: (1) LMSC, firearms, or medications; (2) suicide, safety, or injury; and (3) qualitative methodology, resulting in 6,127 unique records. Two coders developed a coding manual and double-coded 20% of manuscripts (reliability k >.70). We used thematic synthesis to identify barrier and recommendation-related themes using an inductive approach. We identified 19 qualitative studies (18 focusing on firearms, 1 on medications) investigating perspectives of providers (in primary care, mental health, pediatrics, pharmacy, and emergency medicine), patients (parents, primary care patients, veterans, and individuals at risk of suicide), and firearm users. Provider barriers included time constraints, a sense of being unable to control the healthcare system and patient outcomes, lack of firearm expertise, and concerns about the cultural and political tensions surrounding firearms. Patient barriers included perceptions of providers as judgmental, firearm safety as unrelated to healthcare, firearms as low risk, firearm ownership as a private and protected right, safety devices as flawed, and suicide as inevitable. Stakeholders proposed increasing patient and provider engagement in LMSC by having providers receive training to develop cultural competence related to firearms, demonstrate an accepting and unbiased attitude during LMSC, contextualize and provide a rationale for firearm-related discussions, and not directly ask about firearm access in some contexts. Patients also noted a preference for discussing firearms with a trusted provider familiar with firearms or firearm-related values. These findings offer important guidance that may help improve the acceptability, feasibility, and efficacy of LMSC efforts and thereby increase engagement in this intervention.