PLANS to widely implement screening for domestic violence across hospitals and general practice must first ensure adequate systems are in place to support victims, according to experts.
Associate Professor Diana Egerton-Warburton, chair of the Australasian College for Emergency Medicine’s Public Health Committee, told MJA InSight that for emergency doctors, screening for domestic violence “can feel like opening a Pandora’s box”.
Professor Egerton-Warburton said screening could be as simple as asking “do you feel safe at home?”
However, it was the step that came next which was more complex. If a patient disclosed that they were experiencing domestic violence, it should trigger a system of processes to provide them with the support they needed.
Professor Egerton-Warburton was commenting on a study published in JAMA Surgery
which found a high prevalence of domestic violence among trauma patients in the US. (1)
The retrospective analysis included 16 575 trauma patients and found the prevalence of domestic violence was 5.7 cases per 1000 discharges. This prevalence increased among children and adults over the 6-year study period, but remained unchanged for elderly patients.
The authors said their results indicated that there was a lack of proper screening and subsequent reporting of domestic violence in trauma centres, especially among adults and the elderly.
“Initiation of active screening and preventive measures, robust educational campaigns, and uniform screening strategies in trauma centres might help counter this silent epidemic”, they wrote.
Professor Angela Taft, director of the Judith Lumley Centre at La Trobe University’s School of Nursing and Midwifery, told MJA InSight that in Australia, routine screening for domestic violence in adults differed from state to state.
“NSW, for example, has been screening since 2003 in a range of health services, including antenatal, mental health, child and family health, and alcohol and other drugs services. As far as I know, the emergency department is not routinely included”, Professor Taft said.
Professor Egerton-Warburton confirmed that screening for domestic violence in emergency departments (EDs) was not routine, saying it was done on an ad hoc basis in some centres.
She recently conducted a survey of 800 ED clinicians, who were asked about the development of domestic violence screening tools. While these doctors were “keen” on the idea of screening, they did identify several concerns, Professor Egerton-Warburton said.
Some said they did not have enough time and resources to screen for domestic violence, some thought they did not have the specific training required, while others felt it was an issue they were not comfortable discussing with patients.
Professor Egerton-Warburton said it was particularly important to encourage the routine use of a simple, non-invasive screening question in women’s hospitals.
“The question should be asked three or four times during a patient’s stay in hospital, as they may not feel comfortable disclosing that information straight away”.
She said that domestic violence screening should not be restricted to emergency departments, with general practice important in the process “because GPs already have a relationship with the patient. It may not be the exact same question we ask in EDs, but a question should still be asked”.
However, Professor Taft said it was important not to presuppose that screening for domestic violence would translate into positive outcomes.
“There is no evidence, yet, that screening improves the lives of women in any respect, because the supporting systems are not in place.”
Professor Taft coauthored a 2013 Cochrane Review on the screening of women for intimate partner violence in health care settings. (2)
The review included 11 trials on 13 027 women, and found that while screening was likely to increase identification rates, the rates of referral to support agencies were low.
Nevertheless, Professor Egerton-Warburton said that the recent spike in media coverage and public discussion around family violence in Australia indicated that “it is increasingly becoming less of a taboo subject”.
“Now is the time to act on domestic violence because, on an international level, we’re very behind in developing screening methods”, she said.
(Photo: LoloStock / shutterstock)
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