How can clinicians effectively counsel patients about the risk of firearm injury?

How can clinicians effectively counsel patients about the risk of firearm injury?

An NEJM Evidence "curbside consult"

  • by Barnhorst A, Bayer AM, Aubel AJ, Gonzales H, Pallin R, & Wintemute GJ

Quick Summary

  • The 3As Framework for Firearm Injury Prevention Counseling is designed to help clinicians from various disciplines identify patients and clients at risk of firearm homicide, suicide or other injury.

About the Study

IN TWO SENTENCES

Clinicians have a unique opportunity to contribute to the prevention of firearm-related injury and death. The 3As Framework provides clinicians with the tools to have respectful, effective conversations about firearms with their patients and clients, their family members and caregivers.

These conversations can feel difficult. But with training and a risk-based approach, clinicians can guide patients and their families to better understand the risks of having firearms in the home.”

-Amy Barnhorst, professor of psychiatry and director, BulletPoints Project

ABSTRACT

Firearm ownership in the United States is increasing, as is the belief that firearms keep households safe, even though having a firearm in the home increases household members’ risk of firearm injury and death. Research shows that firearm owners and clinicians are receptive to conversations with each other about firearm injury prevention. However, these conversations rarely take place, in part because clinicians lack training on the topic. This Curbside Consult presents the Approach, Assess, Act 3As Framework, which guides clinicians through conversations with patients and clients in clinical situations where firearms pose a risk of injury.

THE 3As FRAMEWORK FOR FIREARM INJURY PREVENTION COUNSELING

The 3As framework is designed to help clinicians from various disciplines identify patients and clients at risk of firearm homicide, suicide or other injury. This includes physicians, physician assistants, nurse practitioners, nurses, psychologists, social workers and therapists. The authors outline three steps — the 3As — clinicians can take to reduce harm from firearms.

Graphic shows the 3As Framework for Firearm Injury Prevention Counseling, outlining steps to Approach, Assess, and Act.
The 3As Framework for Firearm Injury Prevention Counseling as published in NEJM Evidence.

In addition to a deeper dive on the 3As, the paper also includes language-related considerations and phrasing examples and interventions for patients at risk of firearm injury.

Citation

Barnhorst A, Bayer AM, Aubel AJ, Gonzales H, Pallin R, Wintemute G. How Can Clinicians Effectively Counsel Patients about the Risk of Firearm Injury? NEJM evidence. 2025 Dec 23;5(1):EVIDccon2400142.

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Primary Category

Clinical Approaches to Firearm Injury Prevention

Tags

Research