ABSTRACT
Objectives
Chronic conditions, including mild cognitive impairment and depression, place older adults at high risk of firearm suicide. Approximately 40% of older adults have access to a firearm, and many do not store their firearms safely. However, firearm counseling occurs infrequently in clinical settings. Using by the Ottawa Decision Support Framework (ODSF) to conceptualize the decisional support needed by patients and their providers to facilitate firearm counseling, we explore provider perspectives on desired resources for addressing firearm safety with older adult patients.
Methods
From March – August 2022, we conducted 21 semi-structured interviews with primary care providers caring for older adults. We report deductive concepts as well as emergent themes.
Results
Major themes were identified from the three components of the ODSF; decisional needs, decision support and decisional outcomes. Themes included: provider self-efficacy to conduct firearm counseling, clinical workflow considerations, stories for change, patient diagnosis implications, and caregiver involvement.
Conclusions
There is a need for decision aids in the clinical setting that facilitate firearm counseling and promotes shared decision-making about firearm storage.
Clinical Implications
Implementing a decision aid in the clinical setting can improve provider self-efficacy to conduct firearm counseling and help reduce risk factors associated with firearm-related harm among older adults.
KEYWORDS:
Acknowledgments
The authors would like to thank Lauren Rooney for assisting with the project management.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Data availability statement
The authors confirm that the data supporting the findings of this study are available within the article and/or its supplementary materials.
Clinical Implications
A decision aid should be developed and implemented within the primary care setting to assist providers in facilitating firearm counseling with older adult patients.
The decision aid should include information and resources that increase provider knowledge of firearm storage devices and firearm types, while also providing additional guidance on how best to facilitate firearm counseling through conversation starters or discussion prompts.
Older adults with MCI and/or depression are at greater risk for firearm-related harm and should be a priority focus of firearm counseling when utilizing the decision aids in the primary care setting.