Waddle Shelbie D, Reyes Ana M, Thomas Arielle, Betz Marian E, Johnson Julie K, Royan Regina, Ellyin Alexander, Jang Angie, Crandall Marie, Stey Anne M, Campbell Brendan T
From the Department of Trauma (S.D.W., A.T., B.T.C.), American College of Surgeons, Chicago, IL; Department of Surgery (S.D.W., A.T., J.K.J., A.M.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Surgery (A.M.R.), University of Miami Miller School of Medicine, Miami, FL; Department of Surgery (A.T.), Medical College of Wisconsin, Milwaukee, WI; Department of Emergency Medicine (M.E.B.), University of Colorado School of Medicine, Denver, CO; VA Eastern Colorado Geriatric Research Education and Clinical Center (M.E.B.), Rocky Mountain Regional VA Medical Center, Aurora, CO; Department of Emergency Medicine (R.R.), University of Michigan Medical School, Ann Arbor, MI; Rosalind Franklin University of Medicine and Science (A.E.), Chicago, IL; Northwestern University (A.J.), Chicago, IL; Department of Surgery (M.C.), Department of Surgery, Case Western Reserve University, Cleveland, OH; and Department of Pediatric Surgery (B.T.C.), Connecticut Children's Medical Center, Hartford, CT.
J Trauma Acute Care Surg. 2025 Jul 1;99(1):79-88. doi: 10.1097/TA.0000000000004612. Epub 2025 May 20.
Previous work demonstrates that counseling trauma patients on firearm safety is difficult for US surgeons to effectively incorporate into clinical practice. The objective of this study was to understand firearm-owning surgeons' perspectives on their role in firearm injury prevention.
We conducted 1:1 interviews with firearm-owning surgeons who were fellows of the American College of Surgeons (ACS) and treated patients with firearm injuries. Participants were recruited through the ACS Committee on Trauma email listserv with snowball sampling. Inductive and deductive reasoning, based on the Integrated Behavior Model, was used to code and identify themes and subthemes.
Thirty-two firearm owning surgeons were virtually interviewed from April to August 2022. Most were male (78%), White (94%), and practiced in an urban setting (63%). Four themes arose: (1) surgeons believed they had a role in firearm injury prevention, but feared damaging the patient/physician relationship, (2) surgeons should advocate for firearm injury prevention without politicizing firearm ownership, (3) resources and environmental factors impacted clinical integration, and (4) the likelihood of engaging in firearm safety discussions was influenced by patient context and surgeons' perceived credibility as a messenger. Surgeons worried about how conversations would be received by patients and were more comfortable having firearm safety discussions when injuries were accidental or self-inflicted, compared with assault. Some surgeons perceived themselves to be credible messengers due to their firearm knowledge and ownership, while others perceived themselves as not credible while discussing firearms with victims of assault.
Most firearm-owning surgeons believed that firearm injury prevention should be a part of clinical practice, but warranted tailored approaches, considering the credibility of the messenger, injury intent, and local context. More study is required to understand the optimal delivery of firearm safety counseling to specific patient populations.
Prognostic and Epidemiological; Level V.
先前的研究表明，对美国外科医生而言，就枪支安全问题为创伤患者提供咨询很难有效纳入临床实践。本研究的目的是了解拥有枪支的外科医生对其在预防枪支伤害中所扮演角色的看法。
我们对身为美国外科医师学会（ACS）会员且治疗过枪支伤患者的拥有枪支的外科医生进行了一对一访谈。通过ACS创伤委员会的电子邮件列表以滚雪球抽样的方式招募参与者。基于整合行为模型，运用归纳推理和演绎推理对主题和子主题进行编码和识别。
2022年4月至8月，对32名拥有枪支的外科医生进行了虚拟访谈。大多数为男性（78%），白人（94%），且在城市环境中执业（63%）。出现了四个主题：（1）外科医生认为他们在预防枪支伤害中发挥作用，但担心损害医患关系；（2）外科医生应倡导预防枪支伤害，而不将枪支所有权政治化；（3）资源和环境因素影响临床整合；（4）进行枪支安全讨论的可能性受患者情况以及外科医生作为信息传递者的可信度影响。外科医生担心患者对谈话的接受程度，与因袭击受伤相比，当受伤是意外或自我造成时，他们在进行枪支安全讨论时会更自在。一些外科医生因其枪支知识和拥有枪支而认为自己是可信的信息传递者，而另一些外科医生在与袭击受害者讨论枪支时则认为自己不可信。
大多数拥有枪支的外科医生认为预防枪支伤害应成为临床实践的一部分，但鉴于信息传递者的可信度、伤害意图和当地情况，需要采用量身定制的方法。需要更多研究来了解针对特定患者群体提供枪支安全咨询的最佳方式。
预后和流行病学；V级。
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