The intersection between firearm injury prevention and surgical practice: A qualitative study

J Trauma Acute Care Surg. 2025 May 20. doi: 10.1097/TA.0000000000004612. Online ahead of print.

ABSTRACT

BACKGROUND: Previous work demonstrates that counseling trauma patients on firearm safety is difficult for US surgeons to effectively incorporate into clinical practice. The objective of this study was to understand firearm-owning surgeons’ perspectives on their role in firearm injury prevention.

METHODS: We conducted 1:1 interviews with firearm-owning surgeons who were fellows of the American College of Surgeons (ACS) and treated patients with firearm injuries. Participants were recruited through the ACS Committee on Trauma email listserv with snowball sampling. Inductive and deductive reasoning, based on the Integrated Behavior Model, was used to code and identify themes and subthemes.

RESULTS: Thirty-two firearm owning surgeons were virtually interviewed from April to August 2022. Most were male (78%), White (94%), and practiced in an urban setting (63%). Four themes arose: (1) surgeons believed they had a role in firearm injury prevention, but feared damaging the patient/physician relationship, (2) surgeons should advocate for firearm injury prevention without politicizing firearm ownership, (3) resources and environmental factors impacted clinical integration, and (4) the likelihood of engaging in firearm safety discussions was influenced by patient context and surgeons’ perceived credibility as a messenger. Surgeons worried about how conversations would be received by patients and were more comfortable having firearm safety discussions when injuries were accidental or self-inflicted, compared with assault. Some surgeons perceived themselves to be credible messengers due to their firearm knowledge and ownership, while others perceived themselves as not credible while discussing firearms with victims of assault.

CONCLUSION: Most firearm-owning surgeons believed that firearm injury prevention should be a part of clinical practice, but warranted tailored approaches, considering the credibility of the messenger, injury intent, and local context. More study is required to understand the optimal delivery of firearm safety counseling to specific patient populations.

LEVEL OF EVIDENCE: Original Research; Level VI.

PMID:40390162 | DOI:10.1097/TA.0000000000004612