title: Engaging the Voice of Patients Affected by Gender-Based Violence: Informing Practice and Policy.
abstract: BACKGROUND
  Evidence regarding the benefits, opportunities, and risks associated with providing health care to patients experiencing gender-based violence (GBV) and, moreover, their satisfaction with health care services is sparse.
  
  
  METHODS
  Using a patient- and trauma-informed relationship-based framework, survivors of GBV who were referred for follow-up care were asked to participate in a quality improvement (QI) initiative in an effort to understand their perspectives of receiving healthcare services. Patients were asked to answer three open-ended questions in regard to their healthcare experience. Individuals who were eligible for evidence collection after sexual assault (<5 days) were asked two additional questions.
  
  
  RESULTS
  Of the 353 women and six men (359) referred to the C.A.R.E. (Coordinated Approach to Recovery and Empowerment) Clinic, 327 patients were contacted. Of the participants, 24% (86) had a mental health diagnosis; 41% (145) reported their incident to the police; 8% (28) had comorbidities of substance abuse, mental health, and/or homelessness; and 33% (118) of the incidents involved alcohol or drugs. Most of the patients stated that they were well cared for and felt safe during their visit. However, many reported "long waits," "disjointed," "chaotic," "too many" providers, "conflicting" and "miss-information," and "confusion" about what to do after their acute care visit. Over half (59%) did not report incident to the police. Some reported regrets with reporting to the police (16%) and regrets in having evidence collection (15%). Of the patients who did not have evidence collected (47), none expressed regret over choosing not to have evidence collected. Five patients with mental health problems were hospitalized within 5 days of their emergency department visit for suicidal thoughts.
  
  
  CONCLUSIONS
  A number of opportunities to improve the healthcare response were identified. Patients affected by GBV require an improved coordinated and trauma-informed approach. Explicit consent related to evidence collection is needed. Not all patients who have been sexually assaulted should have evidence collected. More extensive research and program evaluation including outcomes research are warranted.
authors.affiliation: Author Affiliation: Brigham and Women's Hospital.
authors.forename: Annie
authors.initials: A
authors.lastname: Lewis-O'Connor
authors.forename: Mardi
authors.initials: M
authors.lastname: Chadwick
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data; D005260:Female; D005783:Gender Identity; D006297:Health Services Accessibility / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D011369:Professional-Patient Relations; D012944:Social Support; D011795:Surveys and Questionnaires; D014754:Violence / Q000331:legislation & jurisprudence / Q000523:psychology / Q000706:statistics & numerical data*; D055815:Young Adult