Development of a patient decision aid to prevent firearm suicide among US women reserve and National Guard Veterans

Abstract: Background: Firearms are the leading method of suicide death among women Veterans, accounting for nearly half of such deaths. Interventions addressing firearm suicide prevention for women Veterans are under-studied. Objective: To develop a patient decision aid (PtDA) tailored for Reserve and National Guard (RNG) women Veterans to promote safe firearm storage and suicide prevention through informed decision-making. Design: Multi-phase mixed-methods study including qualitative interviews, semi-structured surveys. Participants: 86 stakeholders: 60 women Veterans, 26 providers. Approach: Phase 1 qualitative interviews obtained RNG women Veterans’ (n=35) and providers’ (n=26) preferences and recommendations for conversations about firearm suicide risk mitigation. Phase 2 surveyed members of a women Veterans engagement group about the PtDA prototype’s acceptability and utility. Phase 3 interviewed RNG women Veteran gun owners (n=20) about their satisfaction with using the PtDA alone or with shared decision-making (SDM). Key Results: Phase 1 findings informed the PtDA prototype development, refined in Phase 2. In Phase 3, Veterans reported high satisfaction with the PtDA’s information, tone, and preventative approach. Most agreed Veterans could complete the PtDA safety plan without provider assistance. Nearly half (9/20; 45%) reviewing the PtDA using SDM reported having loaded guns accessible at all times. Most (14/20; 70%) indicated SDM made them more likely to identify and act on a safety plan than if they received the PtDA alone. Nearly all (19/20; 95%) agreed VA providers should routinely use SDM when discussing firearms and suicide risk. All would recommend SDM to other Veterans. Most (19/20; 95%) indicated they would follow their plan to talk with someone about holding their firearms. All indicated they would hand off their firearm if their suicide risk escalated. Conclusions: Veterans’ high satisfaction with this PtDA indicates its potential to encourage firearm safety planning, engage support, and foster firearm safety conversations to prevent suicide among women Veterans.