Abstract
BackgroundDespite endorsement by national organizations, the impact of screening for intimate partner violence (IPV) is understudied, particularly as it occurs in different clinical settings. We analyzed interviews of IPV survivors to understand the risks and benefits of disclosing IPV to clinicians across specialties.MethodsParticipants were English-speaking female IPV survivors recruited through IPV programs in Massachusetts. In-depth interviews describing medical encounters related to abuse were analyzed for common themes using Grounded Theory qualitative research methods. Encounters with health care clinicians were categorized by outcome (IPV disclosure by patient, discovery evidenced by discussion of IPV by clinician without patient disclosure, or non-disclosure), attribute (beneficial, unhelpful, harmful), and specialty (emergency department (ED), primary care (PC), obstetrics/gynecology (OB/GYN)).ResultsOf 27 participants aged 18–56, 5 were white, 10 Latina, and 12 black. Of 59 relevant health care encounters, 23 were in ED, 17 in OB/GYN, and 19 in PC. Seven of 9 ED disclosures were characterized as unhelpful; the majority of disclosures in PC and OB/GYN were characterized as beneficial. There were no harmful disclosures in any setting. Unhelpful disclosures resulted in emotional distress and alienation from health care. Regardless of whether disclosure occurred, beneficial encounters were characterized by familiarity with the clinician, acknowledgement of the abuse, respect and relevant referrals.ConclusionWhile no harms resulted from IPV disclosure, survivor satisfaction with disclosure is shaped by the setting of the encounter. Clinicians should aim to build a therapeutic relationship with IPV survivors that empowers and educates patients and does not demand disclosure.
Highlights
Despite endorsement by national organizations, the impact of screening for intimate partner violence (IPV) is understudied, as it occurs in different clinical settings
We explored whether the specialty of care was related to the outcomes of disclosure, and identified a series of factors affecting these outcomes across primary care, obstetrics/gynecology and emergency department specialties
Thirty-one were excluded because they were unrelated to abuse, and did not contribute to the analysis presented in this paper, the impact of IPV disclosure
Summary
Despite endorsement by national organizations, the impact of screening for intimate partner violence (IPV) is understudied, as it occurs in different clinical settings. The extensive physical and mental health burden of intimate partner violence (IPV) exposure has been documented in various settings [1,2,3,4,5,6]. BMC Public Health 2008, 8:229 http://www.biomedcentral.com/1471-2458/8/229 izations hospital standards call for IPV survivor identification and referral to community services. In a complementary set of guidelines, the Family Violence Prevention Fund suggests clinicians inquire about IPV at every encounter for episodic care, such as Emergency Department visits, with higher case-finding rates as the measure of high quality [7].
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