Harriet L. MacMillan, MD; Gene Feder, MD
Potential Conflicts of Interest: Dr. MacMillan: Other: member of the WHO Policy and Clinical Practice Guidelines for Responding to Violence Against Women (report forthcoming), led a randomized, controlled trial of intimate partner violence screening, the results of which were published in the Journal of the American Medical Association in 2009 and are referred to in the systematic review. Dr. Feder: Travel/accommodations/meeting expenses unrelated to activities listed (money to institution): reimbursed by the WHO for attendance at the WHO partner violence guideline development group meeting; Other (money to institution): payment for chairing the United Kingdom NICE domestic violence programme development group.
MacMillan H., Feder G.; Screening Women for Intimate Partner Violence. Ann Intern Med. 2012;157:676. doi: 10.7326/0003-4819-157-9-201211060-00019
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Published: Ann Intern Med. 2012;157(9):676.
TO THE EDITOR:
As 2 clinician-researchers involved in the screening trial (1) that featured prominently in the recent U.S. Preventive Services Task Force (USPSTF) systematic review on screening women for intimate partner violence (IPV) (2), we were perplexed by Nelson and coworkers' conclusion that such screening can provide benefits that vary by population.
This was the only trial identified as meeting the inclusion criteria to address key question 1: “Does screening asymptomatic women in health care settings for current, past, or increased risk for IPV reduce exposure to IPV, physical or mental harms, or mortality?” Given that the trial results showed no differences between groups and that the overall quality of the study was considered “fair,” the answer to key question 1 presumably would be “no,” which is what the trial concluded (1). Even taking into account the limitations of the trial, at most one would expect the answer to be “unknown.” Yet, Nelson and coworkers (2) concluded that IPV screening can provide benefits, extrapolating from trials of IPV interventions recruiting all participants via screening. These trials do not provide evidence for the effectiveness of screening in comparison with other methods of identifying survivors of IPV, such as clinical enquiry or case finding. Educational interventions in primary care that increase IPV disclosure rates and referral for advocacy support do not require implementation of screening (3).
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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