Enhancing the cancer workforce response to domestic abuse

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"Cancer made me weaker to abuse and abuse made me weaker to cancer”: Enhancing the cancer workforce response to domestic abuse

The impact of domestic abuse on mental and physical health is profound and long-lasting. Evidence from the USA shows that this impact extends to screening, care, and treatment for cancer. Complex interventions comprising training, referral pathways to specialist services, and the co-location of a domestic abuse worker have transformed the healthcare response to domestic abuse in a range of clinical practice areas. But to our knowledge, no interventions within cancer workforces have been conducted, evaluated, and published.

Dr Dheensa will outline the results of research with cancer professionals and victim-survivors affected by cancer and domestic abuse. The research showed that domestic abuse did not stop and often worsened after a cancer diagnosis. Abuse affected cancer treatment, surgery, and recovery in ways that led to pain and suffering. Most cancer professionals agreed that they have a responsibility to identify and respond to domestic abuse. Fifty percent had encountered domestic abuse in the past three years. Other professionals said they had likely missed cases, and indeed, of the victim-survivors, less than half reported that they had disclosed domestic abuse to cancer professionals. The two biggest barriers among victim-survivors were not thinking it was relevant to the professional’s role and not being asked the right, or any, questions. Professionals and victim-survivors felt that the cancer setting provided a unique opportunity for domestic abuse to be identified and responded to due to the frequency of contact, length of appointments, continuity of care, and discussion of holistic needs. But lack of confidence and knowledge was a barrier to a good response.

This research has led to an intervention, with domestic abuse coordinators employed in two cancer hospitals. Dr Dheensa will share findings from a midway evaluation, which has indicated marked increases in confidence levels among professionals, and an increase in the rate of domestic abuse cases identified.

Dr Sandi Dheensa is an interdisciplinary, mixed methods, health and social science researcher in the Domestic Violence and Abuse Health Group (DVAHG), University of Bristol, UK.

Her primary research interest is healthcare and public health responses to gender-based violence. She has a particular interest in the intersection of gender-based violence and other disadvantages or vulnerabilities.

Currently, she is leading two studies: CancerDA, a Macmillan Cancer Support-funded project in which she is evaluating an intervention that aims to enhance the cancer workforce response to DVA, and PRESSURE, a study exploring support-seeking and support needs of healthcare professionals who are experiencing, or have experienced, domestic violence and abuse (DVA) themselves. A sister has explored DVA, sexual violence, and child maltreatment among University of Bristol medical students. She also works on REPROVIDE, a randomised controlled trial of a group based domestic abuse perpetrator programme.

Previous projects include ADVANCE, a perpetrator programme for men in substance use treatment services, HERA an evaluation of healthcare-based interventions for gender-based violence in Palestine, Brazil, Sri Lanka, and Nepal, and the Recording & Sharing Domestic violence/abuse Information in Healthcare project, which led to national good practice recommendations.

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