Lock to Live—An Interactive Web-Based Lethal Means Safety Decision Aid for Suicidal Adults: Pilot Randomized Controlled Trial

Abstract

Background Counseling to reduce access to lethal means such as firearms and medications is recommended for suicidal adults but does not routinely occur. We developed the Web-based Lock to Live (L2L) decision aid to help suicidal adults and their families choose options for safer home storage. Objective This study aimed to test the feasibility and acceptability of L2L among suicidal adults in emergency departments (EDs). Methods At 4 EDs, we enrolled participants (English-speaking, community-dwelling, suicidal adults) in a pilot randomized controlled trial. Participants were randomized in a 13:7 ratio to L2L or control (website with general suicide prevention information) groups and received a 1-week follow-up telephone call. Results Baseline characteristics were similar between the intervention (n=33) and control (n=16) groups. At baseline, many participants reported having access to firearms (33/49, 67%), medications (46/49, 94%), or both (29/49, 59%). Participants viewed L2L for a median of 6 min (IQR 4-10 min). L2L also had very high acceptability; almost all participants reported that they would recommend it to someone in the same situation, that the options felt realistic, and that L2L was respectful of values about firearms. In an exploratory analysis of this pilot trial, more participants in the L2L group reported reduced firearm access at follow-up, although the differences were not statistically significant. Conclusions The L2L decision aid appears feasible and acceptable for use among adults with suicide risk and may be a useful adjunct to lethal means counseling and other suicide prevention interventions. Future large-scale studies are needed to determine the effect on home access to lethal means. Trial Registration ClinicalTrials.gov NCT03478501; https://clinicaltrials.gov/ct2/show/NCT03478501

“Lock and Protect”: Development of a Digital Decision Aid to Support Lethal Means Counseling in Parents of Suicidal Youth

“…Alternatively, a broader focus allows greater reach to more patients, enhancing feasibility and potential suicide prevention value. Indeed, the adult L2L DA was expanded to address medication storage and translated to Spanish (20,21). However, this broader focus lengthens the DA with potential for reducing user acceptability.…”

“…Decision aids (DAs) can be developed as digital tools that can augment clinician interactions by offering patients education on potentially difficult decisions, considering their values and personal preferences (19)(20)(21). These clinical tools have been used to support complicated health-related decisions such as those involving medical treatments, end of life care, and disease screening.…”

“…Systematic reviews support the benefits of DAs for enhancing decision-making, decreasing decisional conflict, and improving patient-provider communication and shared decision making (22)(23)(24). More specifically, a recently developed webbased DA to support lethal means counseling in suicidal adults ("Lock to Live, " L2L) has demonstrated feasibility and acceptability with ED patients and providers (19)(20)(21).…”

Lethal Means Counseling for Suicidal Adults in the Emergency Department: A Qualitative Study

“…Participants were a part of a larger study that created a patient-facing decision aid for reducing lethal means access in the context of suicide risk. [14][15][16] Participants were recruited through direct email invitations, posted flyers, and online advertisements. Eligible participants for the parent project were English-speaking, community-dwelling adults (≥ 18 years) in the United States who did not have active suicidal ideation and who belonged to ≥ 1 stakeholder group: those with "lived experience" of suicide risk (either themselves or a family member); suicide prevention professionals; ED providers; and firearm experts.…”

To Prevent Suicide Among Veterans, Their Physicians Should Discuss Gun Safety

“…Additionally, VA clinicians can direct patients to Lock to Live, a decision support tool for those at risk of suicide that provides options for temporarily reducing firearm access. In a small pilot randomized clinical trial of adults at risk of suicide, 7 nearly all participants reported a willingness to recommend this website to others. While more participants in the Lock to Live study group reported a subsequent reduction in firearms access, a larger study will be needed to determine whether this promising result is statistically significant.…”