Background People living with a life-limiting illness are at increased risk of domestic abuse because they are often frail, isolated and dependent on others (Fisher, 2003. J Palliat Med. 6:257; Schmidt, Woods & Stewart, 2006. J Support Oncol. 4:24; Sawin, Laughton, Parker et al., 2009. Oncol Nurs Forum. 36:686; Wygant, Bruera & Hui, 2014. J Pain Symptom Manage. 47:806). Hospices and specialist palliative care teams play a pivotal role in providing holistic care for patients and families, making them well placed to detect and respond to domestic abuse (Feder, Hutson, Ramsey et al., 2006. Arch Intern Med. 166:22). Little is known about domestic abuse and the co-existence of life-limiting illness and existing support for those experiencing or at risk of abuse.
Aim To explore hospice and palliative care practitioners’ experiences of identifying and responding to domestic abuse for patients living with a life-limiting illness.
Methods Semi-structured interviews (n=13) and facilitated workshops (n=4) with health and social care professionals working in hospice and palliative care settings.
Results All participants had experience of patients who had been subjected to domestic abuse. Coercive control, psychological and financial abuse were more common than physical violence and could impact on care and treatment. Domestic abuse was not enquired about routinely, but practitioners were vigilant for ‘red flags’ around safety and wellbeing and employed ‘gut instinct’ when things did not appear right. Practitioners recognised they had a role in identifying and responding to domestic abuse but often lacked confidence to ask or deal with a disclosure. Avoidance of asking about abuse could lead to cases being missed or behaviours being normalised. Practitioners also worried about jeopardising their therapeutic relationship with patients or rapport with carers who may also be the abuser. Domestic abuse was often considered in the context of safeguarding rather than an issue in its own right. This was reflected in a lack of specific training and established referral pathways.
Conclusion People living with a life-limiting illness have increased vulnerability to domestic abuse. Hospice and palliative care practitioners need support and training to increase their knowledge, confidence and skills to support patients experiencing abuse.
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