A Pilot Trial of Suicidal Adults Within Emergency Departments: Enrollment Challenges and Strategies Related to Firearm Access


Reducing access to firearms, medications, and other lethal means for individuals at risk of suicide can save lives. Lethal means counseling often does not occur even though recommended by professional societies. The “Lock to Live” decision aid was developed to help adults with acute suicide risk make decisions about safer storage of firearms and medications.

In a pilot randomized controlled trial, we enrolled 49 English-speaking adults being evaluated for suicide risk in an emergency department (ED). Participants were identified and enrolled in the ED; the intervention was viewing a web-based lethal means storage decision (vs. general suicide prevention information). Follow-up included telephone contact (at 1 week) and medical record review (at 1 and 3 months). The decision aid had high acceptability among enrollees. Larger studies are needed to determine potential effects on storage behavior. Identifying patients within the ED workflow was highly challenging and led to our need to assess and adjust our methods.

The case study explores our challenges related to enrolling patients in clinical research related to sensitive topics (suicide risk and firearm access) in an ED.

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