Conversation starters: Understanding the facilitators and barriers to physician-initiated secure firearm storage conversations

This paper aims to understand what general practice physicians (GPs) perceive as facilitators and barriers to initiating anticipatory guidance around firearm safety. We employ qualitative interviewing to have in-depth conversations with 18 GPs. Participants were randomly selected from a national panel of physicians and screened for specialty (general practice or internist), practice setting (not hospital-based), and time spent on direct patient care (80% +). The sample was stratified at the state level by the presence of safe storage or child access protection laws, with half of the participants selected from each stratum. We identify five physician-perceived barriers to providing secure firearm storage counseling, including inadequate screening mechanisms to trigger conversations, physician perceptions of who is at risk for firearm injury, time pressures, concerns about patient receptivity, and a need for training. Prior to focusing on how to have conversations about firearm safety, interventions designed to increase the incidence of physician-initiated guidance need to address the structural issues of why those conversations typically do not occur. Findings indicate the need for revised screening tools and improved physician education as to who is at risk for gun injury and how to best approach firearm safety conversations. •Comfort is 2nd to screening in determining anticipatory guidance topics.•EMR and insurance are primary determinates of anticipatory guidance topics.•For some, the EMR serves as a secure firearm storage conversation facilitator; others mentioned the lack of firearm-related questions on the EMR as a barrier to screening.•Physicians emphasize the impact patient receptivity has on gun safety conversations.•Time was a common barrier for physicians in safe storage conversations.