The factors associated with disclosure of intimate partner abuse to clinicians

OBJECTIVE Our goal was to identify the prevalence, determinants of, and bar riers to clinician-patient communication about intimate partner abuse. STUDY DESIGN We conducted telephone interviews with a random sample of ethn ically diverse abused women. POPULATION We included a total of 375 African American, Latina, and non-lat ina white a omen aged 18 to 46 years with histories of intimate partner abu se who attended 1 of 3 public primary care clinics in San Francisco, Califo rnia, in 1997. OUTCOMES MEASURED We measured the relevance and determinants of past commun ication with clinicians about abuse and barriers to communication. RESULTS Forty-two percent (159) of the patients reported having communicate d with a clinician about abuse. Significant independent predictors of commu nication were direct clinician questioning about abuse (odds ratio [OR]=4.6 ; 95% confidence interval [CI], 3.2-6.6), and African American ethnicity (O R=1.8; 95% CI, 1.1-2.9). Factors associated with lack of communication abou t abuse included immigrant status (OR=0.6; 95% CI, 0.3-1.0) and patient con cerns about confidentiality (OR=0.7; 95% CI, 0.5-0.9). Barriers significant ly associated with lack of communication were patients' perceptions that cl inicians did not ask directly about abuse, beliefs that clinicians lack tim e and interest in discussing abuse, fears about involving police and courts , and concerns about confidentiality. CONCLUSIONS Clinician inquiry appears to be one of the strongest determinan ts of communication with patients about partner abuse. Other factors that n eed to be addressed include patient perceptions regarding clinicians' time and interest in discussing abuse, fear of police or court involvement, and patient concerns about confidentiality.