Experts, Health Care Providers Challenge Federal Task Force Conclusion, Warn That Less Screening & Intervention Will Endanger Victims Of Abuse
Leading medical and domestic violence experts this week challenged the U.S. Preventive Services Task Force conclusion that there is insufficient evidence to screen patients for domestic violence. Medical leaders from diverse fields asserted that the Task Force used the wrong criteria to assess screening, and warned that more victims and their children will be harmed if health care providers stop assessing for abuse.
The Task Force recommendation was published in the March 2nd issue of the Annals of Internal Medicine. Experts from across the medical and domestic violence communities immediately rejected it as deeply flawed.
"We agree that there should be more research exploring the best ways to screen for abuse and help victims," said Futures Without Violence, formerly Family Violence Prevention Fund President Esta Soler. "But the Task Force conclusion is wrong and, worse, potentially very harmful. The Task Force assessed screening for abuse as a medical screen rather than a behavioral assessment tool, which was a mistake. Furthermore, they ignored hundreds of studies on this topic, simply because researchers did not use control groups. But highly respected researchers around the world have expressed concern about using control groups, because they raise ethical questions about withholding help from patients in danger. The Task Force should have recognized that and examined existing research more fully."
"We stand by our existing policy of routine inquiry about abuse," said American Medical Association President-Elect John Nelson. "Our experience confirms what common sense tells us: When doctors and other health care providers talk to patients about domestic violence and offer referrals and help to those who are victims, battered patients are more likely to take steps to protect themselves and their children. It would be a tragedy if any provider stopped inquiring about family violence as a result of this new recommendation."
Task Force Errors
"There is strong, clear evidence that health care providers can improve women’s safety by intervening to help those who are battered," said Futures Withou Violence Managing Director Debbie Lee, who runs the organization's pioneering health program. "The Task Force would have been wise to look more carefully at other studies on screening for abuse. Health care providers across this nation – some of whom were once reluctant to ask about abuse – can speak to the life-saving benefits of intervention to help victims of domestic violence."
Specifically, experts criticized the Task Force for relying on an evidence report by the Oregon Health & Science University which:
- Used an overly narrow approach by examining screening for domestic violence as a medical screen rather than a behavioral assessment tool, like assessment for substance abuse, unintended pregnancy and safety practices;
- Excluded from their analysis all studies that look at patients presenting with trauma;
- Dismissed all studies that look at pregnant women;
- Discounted a tremendous body of existing research – all but two of 667 studies on intervention, and all but 14 of 806 studies on screening – on the topic;
- Failed to recognize or account for the fact that legitimate ethical considerations led many researchers conducting the aforementioned studies to reject control groups; and
- Misapplied a study that examined mandatory reporting for domestic violence to reach a conclusion about screening for domestic violence.
Experts Endorse Screening and Intervention
"Evidence-based medicine is not yet mature regarding behavioral health issues," said Carden Johnston, MD, FAAP, and President, American Academy of Pediatrics. "Practitioners have to rely on experiences that work and can be replicated. We know that early screening has real positive effects even though some aspects of emotional and psychological stress of child abuse won’t show up in evidence-based studies. We should never minimize the positive things that we can do to help."
"Screening for domestic violence can save lives," said Gail Kincaide, Executive Director of the Association of Women’s Health, Obstetric and Neonatal Nurses. "AWHONN strongly urges nurses to take the time to ask their patients whether they are safe in their homes. This screening is every bit as important as screening for heart disease, breast cancer or cervical cancer and should be an integral part of routine health care."
"Sometimes humanity trumps evidence," wrote Mark S. Lachs, MD, MPH in an editorial accompanying the United States Preventive Services Task Force report in the Annals of Internal Medicine. "For some conditions that clinicians regularly encounter, robotic devotion to evidence-based medicine risks dehumanizing certain aspects of doctoring. Any clinician who has extricated a family violence victim from an abusive situation understands this … We should also act because it’s difficult to read about the dizzying prevalence of family violence and simply conclude that there’s nothing to do because of a lack of proof. What proof is required? ... Our patients and families are suffering, and the relief of suffering is among our mandates."
Click here to access the full response to the Task Force recommendation.
Click here to access the Task Force recommendation.