OHSU Study Shows Health Care Workers Need Training

05/09/05    Portland, Ore.

Even though most health care workers can empathize with patients in abusive relationships when the patient was described as poor or disabled, they have a hard time doing so when the patient is described as educated, healthy or financially secure, according to a study by Oregon Health & Science University researchers published in the May/June edition of the Journal of the Board of Family Practice.

"This is a problem given that domestic violence happens in couples of all socio-economic backgrounds and patients often need compassionate, ongoing medical care while in abusive relationships," said Christina Nicolaidis, M.D., M.P.H., principal investigator of the study. Nicolaidis is an assistant professor of medicine) general internal and geriatrics) and public health and preventive medicine in the OHSU School of Medicine.

In addition, a majority of health care workers had unreasonable expectations about their responsibility in regard to an abused patient. They thought it was up to them to be sure a patient got to a shelter right away if they disclosed abuse, when in reality it usually takes a long time before patients are ready and safe enough to leave a relationship, Nicolaidis said.

Those who thought that it was their responsibility to make sure their patient gets to a shelter right away had more difficulty empathizing with patients who decided to stay with an abusive partner, according to the study results.

"Out of all the characteristics we looked at - including gender, knowledge about domestic violence, prior training, attitudes, screening practices - the one thing that predicted that a provider would score poorly in terms of ability to empathize with patients in abusive relationships was that they agreed with the question meant to assess unreasonable expectations. That implies that we can't just train health care workers about the importance of screening - we also need to be sure they understand the complexities of violent relationships so that they can better empathize with patients experiencing abuse," Nicolaidis said.

Nicolaidis surveyed 278 health care workers in 31 primary care practices in Washington County, Ore. A majority felt it was a primary care providers' responsibility to ask about domestic violence, but few said they actually asked about it, even in settings where there would be a high suspicion for abuse. The research was funded by the Northwest Health Foundation.

The researchers concluded that training of health care workers must focus on helping providers develop more realistic expectations about the complex nature of leaving an abusive relationship. Health care workers need a better understanding of the barriers patients face and why patients may choose to remain in abusive relationships, even if the patient has no health limitations and can afford to leave an abusive partner.