Improving Patient-Centered Suicide Prevention Care in Primary Care

There is a significant need for innovative, engaging, and effective implementation strategies to support high-quality evidence-based suicide prevention care delivery among non-trainee, established primary care members due to the significant gap in training. These strategies need to target not only education about the evidence-based components of suicide prevention, but also the competence to deliver suicide prevention in a patient-centered way as many individuals who commit suicide often see their primary care team in the prior month. In addition, these strategies need to result in provider behaviors that achieve patient outcomes, such as increased likelihood of engagement in resources/safety measures or increasing the likelihood of patients honestly disclosing suicidality or seeking help in the future----leading to the ultimate outcome of reducing the number of suicides. This proposal focuses on a proof-of-concept of an adapted educational program called Learning through Interactive Feedback and training—sUicide Prevention (LIFT-UP). LIFT-UP involves the assessment of trainee skill level during a virtual simulation using a specifically designed measurement tool to optimize measurement followed by structured feedback that is also optimized through attention to specific educational theories. A randomized controlled trial found LIFT-UP increased skill level pre/post with medical trainees and initial pilot work identified LIFT-UP was feasible and acceptable among non-trainee primary care providers. However, several non-trainee primary care provider barriers and preferences were identified. Therefore, these data will direct the adaptation of LIFT-UP to address these barriers and preferences while also addressing two other limitations in existing suicide prevention educational programs. First, it will incorporate strategies based on a theoretical framework to target and increase motivation to change behaviors in clinical practice rather than relying on the initial desire to change, which may be low among established primary care providers. In addition, there is an opportunity to use the LIFT-UP measurement tool to examine whether high levels of suicide prevention skills are predictive of meaningful patient outcomes (e.g., likelihood of engaging in resources, honesty in disclosing in the future to that provider). Therefore, the specific aims involve developing and refining LIFT-UP materials using experts and key stakeholders in primary care. Then, we will examine its feasibility and acceptability on skill development by asking a group of non-trainee primary care providers to complete LIFT-UP. Then, work will be conducted to examine whether high versus low total scores on the LIFT-UP measurement tool predict patient outcomes, such as likelihood of honesty in disclosing suicidality in the future among at-risk primary care patients). If successful, future work would continue to examine the efficacy of LIFT-UP and work towards continuing to improve suicide prevention skill level among non-trainee primary care providers, who play a fundamental role in suicide prevention.