Increasing the Acceptability of Lethal Means Safety Counseling for Firearms: Tips and Scripts for Clinicians, Health System Leaders, and Researchers

In lethal means safety counseling (LMSC), clinicians encourage patients to limit their access to common and lethal means of suicide, especially firearms. However, clinicians may hesitate to deliver this evidence-based intervention. By conducting a systematic review of the growing number of qualitative studies examining stakeholder perspectives on LMSC, we identified stakeholder-recommended strategies for clinicians, health system leaders, and researchers to increase LMSC acceptability. We conducted a pre-registered, comprehensive search for studies up to February 2021 using PubMed and PsycInfo. Thematic synthesis, with an inductive and iterative approach, was used to analyze findings. Eighteen studies examined the perspectives of a various stakeholders across multiple clinical settings on LMSC for firearms. Using relevant themes, we describe strategies and present scripts, rationales, and resources that may increase LMSC acceptability. Clinicians may approach LMSC in a nonjudgmental manner with awareness of their own biases, demonstrate cultural competency by acknowledging the role of firearms in patient’s lives, and adapt LMSC to patients’ previous experiences with firearms, safety, and injury. Clinicians can contextualize and provide a rationale for LMSC, decide whether or not to ask about access to firearms, and recommend a range of storage options tailored to the patient. Free locking devices or coupons for purchasing devices may be distributed. These strategies for potentially increasing the acceptability of LMSC for firearms are the first to be based on a comprehensive set of studies generated by diverse stakeholders. Future efforts should focus on testing them empirically and considering them alongside other relevant outcomes (e.g., feasibility, efficacy).