Patient Opinions of Screening for Intimate Partner Violence

Intimate partner violence (IPV) is described by the American Medical
Association as *a pattern of coercive behaviors that may include repeated
battering and injury, psychological abuse, sexual assault, progressive social
isolation, deprivation, and intimidation*. The long-term consequences of IPV
include health risks, posttraumatic stress disorder, depression, and staggering
economic costs for health care of victims. Victims of IPV make more use of
healthcare than woman who are not involved in IPV.

A survey in 1992 showed that 21% of women in the Netherlands have experienced
physical or sexual violence in a marital or common-law union. In half of these
women it concerned severe physical violence in the current relationship. The
Journal of Trauma reports that the cumulative lifetime prevalence of domestic
violence for women admitted to the emergency department is 54%.

However, IPV is underreported among women who seek medical attention. The
American College of Surgeons position statement on IPV states that surgeons
have the responsibility to identify IPV and appropriately treat women at risk
of further harm (The American College of Surgeons, 2008). We are currently
conducting a study assessing prevalence of IPV in orthopedic and trauma clinics
(PRAISE, MEC 10/042). A pilot study of the PRAISE, conducted in Ontario,
suggests that the high prevalence of IPV in orthopedic trauma clinics warrants
additional resources to identify and manage victims. We seek to assess the
patients attitudes of screening for IPV in orthopedic fracture clinics to
establish if and how patients consider it acceptable to screen for IPV in
orthopedic and/or trauma clinics.

Primary Objective:
Our primary objective is to determine if it is acceptable to patients in the
trauma clinic for orthopaedic/trauma surgeons, orthopaedic/trauma nurses,
and/or social workers in the trauma clinic to screen for IPV.

Secondary Objective(s):

- Whether screening male patients for IPV in the trauma clinic is acceptable to
patients?.

- Who patients in the trauma clinic prefer to screened by for IPV (surgeons,
nurses, social workers).

- How patients prefer screening to occur (what questions should be asked, where
and when should screening occur, how long
should health care providers spend on screening etc.).

- Whether men*s attitudes about screening for IPV differ from women*s.

A cross sectional multicentre study will be performed wherein 750 women and men
will complete a self-reported written questionnaire across three clinical sites
in Canada, in the Academic Medical Center and Onze Lieve Vrouwe Gasthuis in
Amsterdam.

Recruitment of 150 participants will take place at the trauma or orthopedic
clinic at each clinical site. The questionnaires will contain a set of
questions used to asses opinions towards screening for IPV, as well as
questions pertaining to the participant*s demographics.

The measurement instruments that we have selected to use is a self-report
written questionnaire developed by the McMaster University IPV study group and
will be translated in Dutch. Methodological and IPV experts were consulted in
the development of the questionnaire.

If screening for IPV in orthopedic and/or trauma clinics is acceptable to the
majority of patients, this study will serve to advocate for the continued
education of medical professionals to better recognize probable IPV cases and
offer existing services to enhance the care of these patients. This is
especially important because healthcare providers who receive education on
screening and ways to care for IPV victims detect them more readily7.
Furthermore, this study may encourage more open communication between
orthopedic and/or trauma surgeons and their patients, as two major barriers to
IPV detection are either the patient is never asked8 or the healthcare provider
is reluctant to inquire9-11.

Harm for the individual will be minimized by respecting the participant*s
privacy and affirming to him / her that the care she receives is in no way
affected by her decision to participate or not participate in the study. Due
to the nature of the research topic, care must be exercised when recruiting
individuals to participate in the study. Although this study does not ask
participants to disclose IPV, patients may be afraid of speaking about IPV for
fear of retaliation from the offender, stigmatization, embarrassment, and
police involvement7. Because of this fear, key ethical issues addressed in this
study are
1) requirement for free and informed consent,
2) respect for privacy and confidentiality, and
3) maximizing benefit.

To maximize benefit, individuals who are approached to participate in the study
will be offered information resources pertaining to IPV and contact information
of local IPV services in the clinic area. Trauma clinic staff will also be
aware of the study and will also be provided with these materials in the event
that the individual approached would prefer to speak to her care provider(s)
about IPV instead of members of the study team.