Table 1.

Interventionist activities in the Four Supports intervention

Type of Support	Interventionist Actions
Emotional support	• Establish rapport
	• Express empathy
	• Elicit concerns
	• Acknowledge the difficulty of the situation
	• Convey active listening
	• Use touch as appropriate
	• Provide contact information and maintain availability in person or by phone
Communication support	• Elicit family questions
	• Facilitate clinician–family conferences
	• Share information with clinicians about family stressors, structure, questions, and concerns in advance of clinician–family conferences
	• Assist the family to ask questions during conferences
	• Listen for key misunderstandings and concerns after interactions with clinicians and address misunderstandings
	• Ensure understanding of the daily plan and next steps after each encounter
Decision support	• Explain principles of surrogate decision-making
	• Engage in values elicitation
	• Ensure discussion of treatment options, prognosis, and patient values during family conferences
	• Help family synthesize key information from clinicians
	• Maintain focus on the patient as a person
Anticipatory grief support	• Elicit spiritual needs and involve spiritual care as needed
	• Offer the opportunity for the family to gather at the bedside
	• Facilitate life review
	• Create a space for family members to say goodbye
	• Offer to discuss what might happen during the dying process