Department of Emergency Medicine, University of Colorado, School of Medicine, Aurora, CO, United States.
Division of Cardiology, University of Colorado, School of Medicine, Aurora, CO, United States; Adult and Child Consortium for Outcomes Research and Delivery Science, University of Colorado, School of Medicine, Aurora, CO, United States; USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States.
Gen Hosp Psychiatry. 2021 Jul-Aug;71:95-101. doi: 10.1016/j.genhosppsych.2021.04.011. Epub 2021 May 6.
Lethal means safety - counseling and guidance about reducing access to home firearms and medications - is recommended for emergency department patients at risk of suicide. Decision aids are tools that can facilitate potentially difficult decisions by incorporating personal preferences and values. The present study evaluates clinician perceptions about the implementation and utility of "Lock to Live," a lethal means safety decision aid.
One-on-one qualitative interviews were conducted with clinicians (n = 15) at three large emergency departments. Interviewees were asked to evaluate the "Lock to Live" decision tool and its potential implementation and utilization in the emergency department. Interviews were recorded and transcribed. Data were coded via thematic analysis; two coders developed a shared codebook iteratively with high interrater reliability.
Perspectives on the tool fell into three domains: (1) patients (use with patients and families), (2) clinicians, and (3) emergency department system. Interviewees noted that the tool had numerous potential benefits but that its uptake and effectiveness would depend on clinicians' perceptions on its utility, time constraints, and integration into workflow. Addressable concerns related to relationship to other resources, fit within emergency department workflow, and clarification about which emergency department clinician types should use the tool.
"Lock to Live" represents a promising new tool for use in suicide prevention as an aid to lethal means counseling. This qualitative study provides insights into the importance of considering the clinical environment when designing and implementing interventions.
对于有自杀风险的急诊科患者，建议采取致命手段安全咨询和指导，以限制其获得家中枪支和药物的途径。决策辅助工具可以通过纳入个人偏好和价值观来帮助做出潜在困难的决策。本研究评估了临床医生对“Lock to Live”（一种致命手段安全决策辅助工具）实施和实用性的看法。
在三家大型急诊科对临床医生（n=15）进行一对一的定性访谈。受访者被要求评估“Lock to Live”决策工具及其在急诊科的潜在实施和利用。访谈进行了录音并进行了转录。通过主题分析对数据进行了编码；两名编码员通过高评分者间一致性对共享的编码手册进行了迭代开发。
对该工具的看法分为三个领域：（1）患者（用于患者及其家属）、（2）临床医生和（3）急诊科系统。受访者指出，该工具具有许多潜在的益处，但它的采用和有效性将取决于临床医生对其效用、时间限制以及与工作流程的整合的看法。可解决的问题涉及与其他资源的关系、在急诊科工作流程中的适应程度以及澄清哪些急诊科临床医生类型应使用该工具。
“Lock to Live”是预防自杀的一种有前途的新工具，可作为致命手段咨询的辅助工具。这项定性研究深入了解了在设计和实施干预措施时考虑临床环境的重要性。
