title: Juggling confidentiality and safety: a qualitative study of how general practice clinicians document domestic violence in families with children.
abstract: BACKGROUND
  Domestic violence and abuse (DVA) and child safeguarding are interlinked problems, impacting on all family members. Documenting in electronic patient records (EPRs) is an important part of managing these families. Current evidence and guidance, however, treats DVA and child safeguarding separately. This does not reflect the complexity clinicians face when documenting both issues in one family.
  
  
  OBJECTIVE
  To explore how and why general practice clinicians document DVA in families with children.
  
  
  METHODS
  A qualitative interview study using vignettes with GPs and practice nurses (PNs) in England.
  
  
  METHODS
  Semi-structured telephone interviews with 54 clinicians (42 GPs and 12 PNs) were conducted across six sites in England. Data were analysed thematically using a coding frame incorporating concepts from the literature and emerging themes.
  
  
  RESULTS
  Most clinicians recognised DVA and its impact on child safeguarding, but struggled to work out the best way to document it. They described tensions among the different roles of the EPR: a legal document; providing continuity of care; information sharing to improve safety; and a patient-owned record. This led to strategies to hide information, so that it was only available to other clinicians.
  
  
  CONCLUSIONS
  Managing DVA in families with children is complex and challenging for general practice clinicians. National integrated guidance is urgently needed regarding how clinicians should manage the competing roles of the EPR, while maintaining safety of the whole family, especially in the context of online EPRs and patient access.
authors.affiliation: Leeds Institute of Health Sciences, Leeds.
authors.forename: Jessica
authors.initials: J
authors.lastname: Drinkwater
authors.affiliation: School of Social Work, Care and Community, University of Central Lancashire, Preston.
authors.forename: Nicky
authors.initials: N
authors.lastname: Stanley
authors.affiliation: Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol.
authors.forename: Eszter
authors.initials: E
authors.lastname: Szilassy
authors.affiliation: School of Social Work, Care and Community, University of Central Lancashire, Preston.
authors.forename: Cath
authors.initials: C
authors.lastname: Larkins
authors.affiliation: Professor of gender, violence, and international policy, School for Policy Studies, University of Bristol, Bristol.
authors.forename: Marianne
authors.initials: M
authors.lastname: Hester
authors.affiliation: Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol.
authors.forename: Gene
authors.initials: G
authors.lastname: Feder
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D001291:Attitude of Health Personnel; D002648:Child; D002649:Child Abuse / Q000331:legislation & jurisprudence / Q000517:prevention & control; D000068216:Child Protective Services / Q000706:statistics & numerical data; D003219:Confidentiality / Q000941:ethics* / Q000331:legislation & jurisprudence*; D003266:Continuity of Patient Care; D019548:Crime Victims; D017579:Domestic Violence / Q000331:legislation & jurisprudence* / Q000517:prevention & control; D057286:Electronic Health Records / Q000706:statistics & numerical data; D004739:England; D005190:Family / Q000523:psychology; D005260:Female; D058005:General Practitioners / Q000523:psychology; D006801:Humans; D008297:Male; D019221:Mandatory Reporting / Q000941:ethics; D008875:Middle Aged; D010817:Physician-Patient Relations / Q000941:ethics; D017410:Practice Guidelines as Topic; D024382:Professional Role; D036301:Qualitative Research; D012449:Safety / Q000331:legislation & jurisprudence*
keywords: child safeguarding; domestic violence; electronic patient record; general practice; primary care; qualitative research