"You're Not a Victim of Domestic Violence, Are You?" Provider–Patient Communication about Domestic Violence

6 November 2007 | Volume 147 Issue 9 | Pages 620-627

Background: Women who are victims of domestic violence frequently seek care in an emergency department. However, it is challenging to hold sensitive conversations in this environment.

Objective: To describe communication about domestic violence between emergency providers and female patients.

Design: Analysis of audiotapes made during a randomized, controlled trial of computerized screening for domestic violence.

Setting: 2 socioeconomically diverse emergency departments: one urban and academic, the other suburban and community-based.

Participants: 1281 English-speaking women age 16 to 69 years and 80 providers (30 attending physicians, 46 residents, and 4 nurse practitioners).

Results: 871 audiotapes, including 293 that included provider screening for domestic violence, were analyzed. Providers typically asked about domestic violence in a perfunctory manner during the social history. Provider communication behaviors associated with women disclosing abuse included probing (defined as asking 1 additional topically related question), providing open-ended opportunities to talk, and being generally responsive to patient clues (any mention of a psychosocial issue). Chart documentation of domestic violence was present in one third of cases.

Limitations: Nonverbal communication was not examined. Providers were aware that they were being audiotaped and may have tried to perform their best.

Conclusion: Although hectic clinical environments present many obstacles to meaningful discussions about domestic violence, several provider communication behaviors seemed to facilitate patient disclosure of experiences with abuse. Illustrative examples highlight common pitfalls and exemplary practices in screening for abuse and response to disclosures of abuse.

Editors' Notes Context Victims of domestic violence often seek care in emergency departments. Contribution This study examines 293 audiotaped visits to 2 emergency departments during which providers screened adult women for domestic violence. Providers' queries were often perfunctory. They usually did not include follow-up probing or offer open-ended opportunities to talk. Seventy-seven women disclosed domestic violence during the interviews; however, providers documented only 24 of the disclosures and referred only 19 women for counseling. Caution Audiotapes were made during a randomized trial that was testing computer screening for domestic violence. Providers knew they were being audiotaped. Implication Poor communication with victims of domestic violence is probably very common in emergency departments. —The Editors

 

Author and Article Information

From School of Social Policy & Practice, University of Pennsylvania, Philadelphia, Pennsylvania; Indiana University School of Medicine, Regenstrief Institute, and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana; The University of Chicago, Chicago, Illinois; and The University of Toronto, Toronto, Ontario, Canada.

Acknowledgment: The authors thank Mindy Drum, PhD; David Howes, MD; Laura McCloskey, PhD; Melissa Dichter, MSW; and Joanna Bisgaier, BA, for instrumental support and insightful feedback. They also thank the many helpful internal and external reviewers, and the faculty, residents, staff, and patients of the University of Chicago Emergency Medicine Program.

Grant Support: By the Agency for Healthcare Research and Quality (grant RO1 HS 11096-03). Dr. Rhodes is also supported by grant K23 MH64572 from the National Institute of Mental Health.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Karin V. Rhodes, MD, MS, Division of Health Care Policy Research, Department of Emergency Medicine, School of Social Policy & Practice, University of Pennsylvania, 3815 Walnut Street, Room 201, Philadelphia, PA 19104; e-mail, kvr{at}sp2.upenn.edu.

Current Author Addresses: Dr. Rhodes: Division of Health Care Policy Research, Department of Emergency Medicine, School of Social Policy & Practice, University of Pennsylvania, 3815 Walnut Street, Room 201, Philadelphia, PA 19104.

Dr. Frankel: Indiana University School of Medicine, Indianapolis, IN 46202.

Ms. Levinthal and Ms. Prenoveau: University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637.

Ms. Bailey: 1655 North Burlington Street, #1, Chicago, IL 60614.

Dr. Levinson: University of Toronto, 190 Elizabeth Street, #3-805, Toronto, Ontario M5G 2C4, Canada.

Author Contributions: Conception and design: K.V. Rhodes, R.M. Frankel, W. Levinson.

Analysis and interpretation of the data: K.V. Rhodes, N. Levinthal, R.M. Frankel, E. Prenoveau, W. Levinson.

Drafting of the article: K.V. Rhodes, R.M. Frankel, N. Levinthal, E. Prenoveau.

Critical revision of the article for important intellectual content: K.V. Rhodes, R.M. Frankel, N. Levinthal, W. Levinson.

Final approval of the article: K.V. Rhodes, R.M. Frankel, J. Bailey, W. Levinson.

Provision of study materials or patients: K.V. Rhodes.

Obtaining of funding: K.V. Rhodes, W. Levinson.

Administrative, technical, or logistic support: K.V. Rhodes, E. Prenoveau, J. Bailey.

Collection and assembly of data: K.V. Rhodes, R.M. Frankel, E. Prenoveau, J. Bailey.

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