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‘Lock to Live’: development of a firearm storage decision aid to enhance lethal means counselling and prevent suicide
  1. Marian E Betz1,
  2. Christopher E Knoepke2,3,
  3. Bonnie Siry1,
  4. Ashley Clement1,
  5. Deborah Azrael4,
  6. Stephanie Ernestus5,
  7. Daniel D Matlock3,6,7
  1. 1 Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
  2. 2 Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
  3. 3 Adult and Child Consortium for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado, USA
  4. 4 Harvard Injury Control Research Center, Harvard School of Public Health, Boston, Massachusetts, USA
  5. 5 Department of Psychiatry, University of California Los Angeles, Los Angeles, California, USA
  6. 6 Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
  7. 7 VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, Colorado, USA
  1. Correspondence to Dr Marian E Betz, Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado 80045, USA; marian.betz{at}


Objectives We sought to (1) clarify decision needs among suicidal adults with home firearm access; (2) identify accurate, unbiased and acceptable approaches for content and messaging; and (3) develop a tablet-delivered decision aid for firearm storage options.

Methods Following international standards, we used stakeholder interviews to develop a decision aid for the decision, ‘what option(s) to choose to reduce home access to firearms for an adult at risk of suicide’. Participants were adults with personal or family history of suicidal ideation or behaviours, firearm ownership or employment in a firearm range or store, involvement in suicide prevention field, or work as emergency department or other healthcare provider.

Results Through 64 interviews, we created the ‘Lock to Live’ decision aid, which includes (1) introduction specifying the decision, (2) clarification of preferences and logistics, (3) table of storage options and (4) summary with specific next steps. The final tool had high user acceptability.

Conclusions Should the ‘Lock to Live’ decision aid prove useful in a pilot feasibility trial and subsequent testing, it could enhance lethal means counselling and help prevent firearm suicide.

  • suicide/self?harm
  • firearm
  • counseling

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  • Correction notice This article has been corrected since it was published online first. The name of one of the authors, Daniel D Matlock, has been corrected.

  • Contributors MEB, CEK, DA and DDM conceived the study and obtained funding. AC and BS coordinated and completed interviews and managed data, with help from MEB. All authors discussed interview results and decision aid iterations. MEB and AC managed the overall study. MEB, CEK and BS drafted the manuscript, and all authors contributed substantially to data manuscript revision. MEB takes responsibility for the paper as a whole.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Colorado Multiple Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.