Clinician Attitudes, Screening Practices, and Interventions to Reduce Firearm-Related Injury

Abstract

<jats:p>Firearm injury is a leading cause of injury-related morbidity and mortality in the United States. We sought to systematically identify and summarize existing literature on clinical firearm injury prevention screening and interventions. We conducted a systematic search of PubMed, Web of Science, Cumulative Index of Nursing and Allied Health Literature (CINAHL), PsycInfo, and ClinicalTrials.gov for English-language original research (published 1992–2014) on clinical screening methods, patient-level firearm interventions, or patient/provider attitudes on the same. Unrelated studies were excluded through title, abstract, and full-text review, and the remaining articles underwent data abstraction and quality scoring. Of a total of 3,260 unique titles identified, 72 were included in the final review. Fifty-three articles examined clinician attitudes/practice patterns; prior training, experience, and expectations correlated with clinicians' regularity of firearm screening. Twelve articles assessed patient interventions, of which 6 were randomized controlled trials. Seven articles described patient attitudes; all were of low methodological quality. According to these articles, providers rarely screen or counsel their patients—even high-risk patients—about firearm safety. Health-care–based interventions may increase rates of safe storage of firearms for pediatric patients, suicidal patients, and other high-risk groups. Some studies show that training clinicians can increase rates of effective firearm safety screening and counseling. Patients and families are, for the most part, accepting of such screening and counseling. However, the current literature is, by and large, not high quality. Rigorous, large-scale, adequately funded studies are needed.</jats:p>

Hospital Emergency Department Lethal Means Counseling for Suicidal Patients

“…Prior work, including the large ED-Safety Assessment and Follow-up Evaluation (ED-SAFE) trial, documents that ED clinicians often do not routinely counsel about lethal means 21,22,33–36 and their counseling can be improved. 37 Even with political sensitivities about guns, 38 patients are receptive to receiving guidance, 19,39–41 and counseling can improve storage practices.…”

Yes, You Can: Physicians, Patients, and Firearms

“…For example, a recent systematic review identified no studies of the accuracy or predictive value of screening for firearm access among high-risk patients (5). Such absence of evidence is common.…”

“…We then discuss the circumstances in which prevention efforts might be most appropriate. We briefly review other barriers to their more widespread adoption, patients' opinions about physicians addressing firearms, and the effectiveness of such prevention practices; more extensive information is available elsewhere (5,6). We offer specific recommendations, based on the limited evidence available, for how physicians can incorporate firearm-related injury prevention into the care of their patients.…”

A Consensus-Driven Agenda for Emergency Medicine Firearm Injury Prevention Research

“…Most research on firearm injury prevention interventions has been conducted outside of the ED. 45 Future work should determine the theoretical basis, format, and demographic tailoring of ED-based interventions to prevent all types of firearm injury, and to reduce harm after an injury or death has occurred. Interventions must then be rigorously developed and tested for efficacy, effectiveness, and disseminability.…”