title: Disclosing intimate partner violence to health care clinicians - what a difference the setting makes: a qualitative study.
abstract: BACKGROUND
  Despite 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.
  
  
  METHODS
  Participants 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)).
  
  
  RESULTS
  Of 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.
  
  
  CONCLUSIONS
  While 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.
authors.affiliation: Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Ave, Boston, MA 02118, USA . jane.liebschutz@bmc.org
authors.forename: Jane
authors.initials: J
authors.lastname: Liebschutz
authors.forename: Tracy
authors.initials: T
authors.lastname: Battaglia
authors.forename: Erin
authors.initials: E
authors.lastname: Finley
authors.forename: Tali
authors.initials: T
authors.lastname: Averbuch
mesh_terms: D000293:Adolescent; D000328:Adult; D018585:Battered Women / Q000523:psychology / Q000706:statistics & numerical data*; D044383:Black People / Q000523:psychology / Q000706:statistics & numerical data; D017579:Domestic Violence / Q000208:ethnology / Q000523:psychology*; D005260:Female; D006630:Hispanic or Latino / Q000523:psychology / Q000706:statistics & numerical data; D006801:Humans; D007407:Interviews as Topic; D008403:Mass Screening; D008404:Massachusetts; D008875:Middle Aged; D017060:Patient Satisfaction / Q000208:ethnology; D011369:Professional-Patient Relations; D036301:Qualitative Research; D012650:Self Disclosure; D044465:White People / Q000523:psychology / Q000706:statistics & numerical data; D001741:Black or African American