Addressing domestic abuse in cancer care: Developing and piloting a specialized intervention for healthcare professionals.

Abstract

e13549 Background: Over 20% of people in England and Wales have lifetime experience of domestic abuse (DA)—i.e. family violence. Healthcare-based DA interventions increase professionals’ identification rate of DA among patients, yet no cancer-care based DA interventions exist. DA is linked to a higher likelihood of cancer diagnosis, later diagnosis stage, higher depression, stress, poorer quality of life and physical, social, and emotional functioning. We aimed to enhance the cancer workforce response to DA. Methods: We developed and administered a national survey and follow-up interviews to professionals and survivors (who had a cancer diagnosis or experienced DA from someone with the diagnosis) to explore experiences of the cancer-DA intersection. We used findings to adapt a generic hospital-based DA coordinator role to a cancer-specific setting and pilot an intervention. The core intervention component was the coordinators’ training and monitoring process. We used an explanatory sequential design, comprising a survey pre-training, immediately post-training, and 6 months post-training, with follow-up interviews, to assess pre-training preparedness to identify and respond to DA explore changes post-training. Results: Survey respondents were 20 DA survivors and 334 professionals mostly from acute/community healthcare. DA often worsened after a cancer diagnosis. Abuse affected cancer treatment, surgery, and recovery. Most professionals expressed a responsibility to identify and respond to DA. They and survivors felt that the cancer setting was a unique opportunity to identify and respond to DA response to due frequent contact, appointment length, continuity of care, and holistic approaches. Lack of confidence and knowledge were barriers. Professionals were eager to improve their response and wanted specialist training. Two coordinators were hired in two cancer centres. Coordinators trained 1080 staff (17% of staff across two sites). Survey 1 (Time 1 & 2) response rate was 44.9% (n = 485) and survey 2 8.8% (n = 95) (Time 3). All confidence scores significantly increased from pre- (Time 1) to post-training (Time 2). Time 3 also saw significant gains. There were also highly significant decreases in the perception of most barriers to asking about and responding to domestic abuse post-training. Site 1’s identification rate increased. Qualitative findings shed light on key moderators between intervention components and outcomes, and additional components needed to change practice. Conclusions: Our evaluation shows a need for a DA response in the cancer setting. We showed it is possible to adapt a generic role for the cancer context, train staff, improve confidence and identification rates with specialised training. Our outputs are a training package and toolkit for good practice (available online). Our next steps are to develop trauma-informed cancer treatment for patients.