Improving Fidelity of Patient-Centered Suicide Prevention Care in Primary Care

This R34 application aims to adapt and conduct pilot work on the Learning through Interactive Feedback and Training-sUicide Prevention (LIFT-UP) educational program as a strategy to enhance current implementation strategies. While there are many strategies designed to assist providers in suicide prevention, they often focus heavily on supporting provider’s delivery of content, such as lethal means (LM) safety, and ignore developing provider’s skill for how to ask in a patient-centered manner. Improving the skill by which providers have LM conversations should in turn increase patient’s willingness to decrease access to LM and increase future disclosure. LIFT-UP, was developed to support provider’s broad suicide prevention skill development through the utilization of an algorithmic assessment tool that rates provider’s skill during a virtual simulation with an actor followed by the provision of structured constructive verbal feedback. Utilizing recent research on patient perspectives on LM communication and the Theory of Planned Behavior+Risk Perception, we aim to further adapt LIFT-UP by: 1) incorporating components attending to patient-centered LM communication through the alteration of the assessment tool and 2) addressing provider motivation by adding written expert feedback that shares behavioral strategies to improve, normative information, and patient outcome awareness. Therefore, Aim 1’s objective is to continue to refine and optimize the LIFT- UP assessment tool and feedback through obtaining perspectives from: 1a) 32 diverse patients (i.e., firearm owners, patients with a history of intimate partner violence, patients who use opiates) on face and concurrent validity of high vs. total scores and specific LM dimensions using recorded simulations and 1b) 12 healthcare providers on the acceptability, appropriateness, informativeness, and ability to motivate change of the verbal and written feedback. After using the information in Aim 2 to make refinements to LIFT-UP (1c), Aim 2 involves a pilot randomized control trial (with crossover) where 50 primary care staff will be assigned to one of two conditions 1) usual care (UC) or 2) UC plus LIFT-UP. We hypothesize that the pilot clinical trial will result in providers rating LIFT-UP with high levels of appropriateness and acceptability and that they will demonstrate increased fidelity to patient- centered LM skills, be willing to participate in additional LM trainings, and report higher adoption of LM skills than those who engage in UC alone. Results will inform future work towards a large cluster randomized clinical trial examining the predictive validity of LIFT-UP’s assessment tool and the effectiveness of LIFT-UP in enhancing implementation efforts. Project Number: 1R34MH140355-01 | Fiscal Year: 2025 | NIH Institute/Center: National Institute of Mental Health (NIMH) | Principal Investigator: Jennifer Funderburk | Institution: VETERANS HEALTH RESEARCH INSTITUTE OF CENTRAL NEW YORK, INC., SYRACUSE, NY | Award Amount: $502,500 | Activity Code: R34 | Study Section: Special Emphasis Panel[ZMH1 ERB-N (02)] View on NIH RePORTER: https://reporter.nih.gov/project-details/11139113