Conversations between clinicians and their patients about firearms could save lives

Health care providers who counsel their patients about firearm safety and prevention could prevent future injury or death, including suicides, violent injuries and unintentional injuries resulting from firearms, according to a University of Michigan report.

In an article published in the New England Journal of Medicine, researchers at U-M’s Institute for Firearm Injury Prevention make the case for including counseling for firearm safety as a regular part of patient care and offer their report as a resource for clinicians and health care systems.

Their article, “Clinical Approaches to the Prevention of Firearm-Related Injury,” provides a review of evidence-based strategies doctors and other clinicians can use with their patients, as well as data on firearm deaths and injuries and a breakdown of prevention approaches for different populations.

Strategies include screening for firearm availability and access, counseling around gun safety and locked storage, and tailored screening and intervention strategies for preventing firearm-related suicide, intimate partner violence, community violence and older adult firearm injury.

“Clinicians have a unique opportunity to engage with patients on firearm safety to prevent firearm suicide, unintentional injury and interpersonal violence by offering critical interventions that have been shown to reduce injury risk,” said co-author Patrick Carter, co-director of the Institute for Firearm Injury Prevention and professor of emergency medicine at the Medical School. He is also a professor of health behavior and health equity at the School of Public Health.

“Further, research shows that when done in the right way, patients are receptive to these discussions with their providers, and they can make a difference in the decisions that patients make in their own home with regard to firearm safety,” Carter said.

Rebecca Cunningham, former U-M vice president for research and innovation and longtime firearm injury prevention researcher, co-authored the article. She was named president of the University of Minnesota earlier this year.

The researchers’ guidance comes just months since the U.S. surgeon general declared gun violence an urgent public health crisis.

Firearms are a leading cause of death affecting all demographics, often leading to lifelong physical and mental health effects for survivors, as well as lasting impacts for families, friends and communities. Firearms are also the leading cause of death for children and adolescents ages 1-19.

In addition to approaches and strategies for clinicians, the article also provides resources such as sample clinical screening questions to use with patients to initiate discussions around gun safety, step-by-step guidance on how to have evidence-based conversations with patients about firearm safety, and an overview of firearm storage methods.

In addition, Carter and Cunningham highlight the importance of nonjudgmental, patient-centered counseling that respects patients’ rights and motivations for firearm ownership, noting that counseling is most effective when clinicians align safety recommendations with patient motivations, goals and values.

They also outline steps for health care leaders to take to move prevention efforts forward in their health care systems, including by supporting the implementation of evidence-based counseling programs and providing for additional clinician education to enhance the use of evidence-based programs in clinical practice.

“Despite past funding limitations, we now have a base of scientific evidence to support effective clinical practices to reduce firearm injuries,” Carter said. “It’s crucial for health care systems to provide clinicians with the necessary time, training and resources to integrate evidence-based strategies for reducing firearm injuries and death into their clinical practice.

“We hope that this article can be a resource for clinicians and hospital systems that want to have an impact on reducing firearm injury risk in their patient populations and communities.”

Citation: Clinical Approaches to the Prevention of Firearm-Related Injury, NEJM, DOI:10.1056/NEJMra2306867