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RCT
ACE Report #5059

QOL in women experiencing IPV did not improve following counselling from family doctor


Study Type:Therapy
OE Level Evidence:2
Journal Level of Evidence:N/A

Screening and counselling in the primary care setting for women who have experienced intimate partner violence (WEAVE): a cluster randomised controlled trial

Lancet. 2013 Apr 15. pii: S0140-6736(13)60052-5. doi: 10.1016/S0140-6736(13)60052-5

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Synopsis

52 family doctors were randomized to provide their female patients (272 female patients in total), who screened positive for intimate partner violence (IPV), with either counselling sessions or give them resource cards and provide usual care, in order to compare the quality of life, safety planning and behaviours, and mental health status between the women). Following 12 months, results indicated that counselling from a family doctor did not improve the quality of life, safety planning and behaviours, mental health, anxiety symptoms, or comfort to discuss fears in women. Patients, who received counselling sessions, however did experience a decrease in depression symptoms, and were more regularly asked about their own and their child’s safety.

Publication Funding Details +
Funding:
Non-Industry funded
Sponsor:
Australian National Health and Medical Research Council
Conflicts:
None disclosed

Risk of Bias

5/10

Reporting Criteria

18/20

Fragility Index

N/A

Was the allocation sequence adequately generated?

Was allocation adequately concealed?

Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?

Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?

Blinding Patients: Was knowledge of the allocated interventions adequately prevented?

Was loss to follow-up (missing outcome data) infrequent?

Are reports of the study free of suggestion of selective outcome reporting?

Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?

Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?

Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?

Yes = 1

Uncertain = 0.5

Not Relevant = 0

No = 0

The Reporting Criteria Assessment evaluates the transparency with which authors report the methodological and trial characteristics of the trial within the publication. The assessment is divided into five categories which are presented below.

4/4

Randomization

2/4

Outcome Measurements

4/4

Inclusion / Exclusion

4/4

Therapy Description

4/4

Statistics

Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65

The Fragility Index is a tool that aids in the interpretation of significant findings, providing a measure of strength for a result. The Fragility Index represents the number of consecutive events that need to be added to a dichotomous outcome to make the finding no longer significant. A small number represents a weaker finding and a large number represents a stronger finding.

Why was this study needed now?

Women involved in intimate partner violence (IPV) often confide in their family doctors first. However, currently little evidence exists in regard to how doctors should act in response to women who screen positive for IPV. It has been suggested that offering a structured intervention would be of benefit to these identified women in terms of increasing their comfort to discuss abuse, and improve their safety planning and mental health. Therefore, this study aimed to determine whether counselling from a family doctor would improve the quality of life, safety planning and behaviours, and mental health in women who screened positive for IPV.

What was the principal research question?

Was there improvement in the quality of life, safety planning and behaviours, and mental health in female patients who screened positive for IPV after receiving counselling sessions from their family doctor compared to standard care, when measured over a period of 12 months?

Study Characteristics -
Population:
52 doctors who worked at least 3 sessions per week, who used electronic records, and had at least 70% of patients who spoke English (Mean age: 48.1 +/- 8.1). 272 female patients who had screened positive in a health and lifestyle survey for fear of an intimate partner in the past 12 months (Mean age: 38.5 +/- 8.1)
Intervention:
Counselling group: Doctors underwent the Healthy Relationships Training programme based on the Psychosocial Readiness Model, consisting of a 6 hours distance learning package and two 1 hour interactive practice visits. The programme aimed to teach doctors how to run a short counselling session with positive IPV screened women. Doctors also received a basic IPV education pack and Continuing Professional Development points. Female patients of these doctors who were fearful of their partner took part in 1-6 counselling sessions (number received depended on the patient’s needs) and received a list of resources (Mean age of doctors: 49.3 +/- 8.4; Mean age of women: 37.9 +/- 8.8) (n=25 doctors, 137 women; 23 doctors and 96 women completed final follow-up)
Comparison:
Control group: Doctors received a basic IPV education pack and Continuing Professional Development points. Female patients of these doctors who were fearful of their partner received a list of resources from their doctors and received usual care if they came in with any concerns (Mean age of doctors: 46.9 +/- 7.7; Mean age of women: 39.1 +/- 7.3) (n=27 doctors, 135 women; 26 doctors and 100 women completed final follow-up)
Outcomes:
The primary outcome measures were quality of life (measured using the WHO Quality of Life-BREF (WHOQOL-BREF)), mental health (measured using SF-12 form), safety planning (assessed on whether patients had ever created a safety plan and, if so, how many), and behaviour (evaluated using the Safety-Promoting Behaviour Checklist). Secondary outcome measures included depression and anxiety (measured using the Hospital Anxiety and Depression Scale (HADS)), whether doctors inquired about the safety of the women and their children, and comfort level to discuss fear of their partner with the doctor (measured using a 5-point Likert Scale)
Methods:
RCT: prospective; multicentre
Time:
Outcomes were measured at baseline and at 6 and 12 months following intervention

What were the important findings?

  • When measured at 6 and 12 months, the mean WHOQOL-BREF scores did not differ significantly between the intervention and control group (Adjusted p>0.05), except for the physical subscale score at 6 months (Intervention: 64.2 +/- 22.4; Control: 60.2 +/- 18.0) (Adjusted p= 0.008).
  • At 6 months there was no significant difference between groups in the number of patients who had ever had a safety plan (6 months: Adjusted p=0.71). However, at 12 months significantly more patients had a safety plan in the intervention group (43 patients; 45%), in comparison to the control group (27 patients; 28%) (Adjusted estimated effect size: 2.4; Adjusted 95% CI: 1.2-4.9; Adjusted p=0.01).
  • There was no significant difference between groups in the number of patients who had a HADS depression score of at least 8 at 6 months (Adjusted p= 0.08).
  • At 6 months the number of patients who were inquired by their doctor about their safety was significantly higher in the intervention group (30 patients; 32%), compared to the control group (12 patients; 13%) (Adjusted odds ratio: 3.5; Adjusted 95% CI: 1.7-7.5; Adjusted p=0.001). The number of patients inquired by their doctor about their safety dropped from 6 to 12 months for both groups, but remained slightly higher in the intervention group (19 patients; 20%), compared to the control group (11 patients; 11%) (Adjusted p=0.08).
  • At both 6 and 12 months the number of patients who were inquired by their doctor about their child's safety was significantly higher in the intervention group (6 months: 16 patients, 37%; 12 months: 11 patients, 22%), compared to the control group (6 months: 11 patients, 18%; 12 months: 6 patients, 9%) (6 months: Adjusted odds ratio: 6.0, Adjusted 95% CI: 1.7-20.5, Adjusted p=0.005; 12 months: Adjusted odds ratio: 3.8, Adjusted 95% CI: 1.1-13.3, Adjusted p=0.04).
  • There were no significant differences between groups for the mean SF-12 mental health status scores (6 months: Adjusted p=0.60; 12 months: Adjusted p=0.15), the number of patients with more than 5 safety behaviours (6 months: Adjusted p=0.63; 12 months: Adjusted p=0.49), the number of patients with a HADS anxiety score of at least 8 (6 months: Adjusted p=0.29; 12 months: Adjusted p=0.67), and the number of patients comfortable to discuss fear (12 months: Adjusted p=0.59).

What should I remember most?

The results collected over 12 months displayed that counselling sessions provided by doctors to female patients who screened positive for intimate partner violence did not improve the women’s quality of life, safety planning and behaviour, global mental health, anxiety symptoms, or comfort to discuss fears. However, patients who received counselling sessions experienced a reduction in depression symptoms, and more frequently asked about their and their child’s safety, in comparison to the control group.

How will this affect the care of my patients?

More research is necessary in determining how to increase the number of women identified who experience intimate partner violence. As well, further research is warranted in developing interventions that may improve the quality of life, safety planning and behaviour, and global mental health in women. Furthermore, conducting a study regarding intimate partner violence for male patients may be worth consideration.

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