whatever their reason
for seeking medical attention, is not
justified, according to a new report by
researchers at the
University of Bristol, funded by the
National Institute for Health Research
Health Technology Assessment (NIHR HTA)
programme.
However, doctors and
nurses need better training to respond
to domestic violence and the NHS should
consider commissioning specialist
domestic violence services to which
doctors can refer women, the lead author
of the report says.
Domestic or partner
violence affects at least one in four
women at some point in their lives. It
can do long-term damage to physical and
mental health and causes two deaths a
week in the UK. Although doctors and
nurses deal all the time with the
consequences of domestic violence, the
health service has been slow to respond
to the needs of women currently
experiencing abuse.
One proposal for
improving care has been a policy whereby
all women, regardless of their reason
for seeking medical attention, are asked
by doctors and nurses if they have
experienced domestic violence. This is
called screening and has been effective
in other areas, for example in
detecting thyroid disease in babies and
raised blood pressure in adults.
Gene Feder, Professor
of Primary Health Care at the University
of Bristol and colleagues in Bristol,
London, Manchester and Australia
reviewed research evidence for a
domestic violence screening programme in
the NHS.
They looked at all
published studies of:
- the prevalence of
domestic violence against women in
the UK population and among patients
- the health
consequences for women and their
children
- screening
questions that can be used by
doctors and nurses
- the acceptability
of screening to women and clinicians
- the effectiveness
of specific care for women once they
have disclosed abuse
- the
cost-effectiveness of domestic
violence screening programmes.
The overall conclusion
of the review was that there was not
enough evidence to justify asking all
women about domestic violence when they
consult a doctor or a nurse, whether
this is in hospital or general
practice.
Professor Feder said:
"The debate over screening for domestic
violence in health care settings has
diverted attention away from the
uncontroversial need to train doctors
and nurses in asking patients about
their experiences of abuse and in
responding appropriately when women do
disclose. This is largely neglected in
undergraduate and postgraduate medical
education.
"We need more research
on how clinicians can best respond to
this large public health problem. The
evidence we have reviewed on
effectiveness of specific care after
disclosure of abuse, particularly
domestic violence advocacy, supports a
case for the NHS commissioning
specialist domestic violence services to
which clinicians can refer women."
Professor Feder has
recently been appointed an expert
advisor to the World Health Organisation
on the development of guidance on the
health sector response to violence
against women.
The report was
authored by researchers at the
University of Bristol, Queen Mary,
University of London, London School of
Hygiene and Tropical Medicine,
University of Manchester and Deakin
University, Australia.
How far does screening women for
domestic (partner) violence in different
health-care settings meet criteria for a
screening programme? Systematic reviews
of nine UK National Screening Committee
criteria by G Feder, J Ramsay, D
Dunne, M Rose, C Arsene, R Norman, S
Kuntze, A Spencer, L Bacchus, G Hague, A
Taket, and A Warburton. Health
Technology Assessment 2009; Vol. 13.17
The debate over
screening for domestic violence in
health care settings has diverted
attention away from the uncontroversial
need to train doctors and nurses in
asking patients about their experiences
of abuse and in responding appropriately
when women do disclose. This is largely
neglected in undergraduate and
postgraduate medical education. |
