EW ISSUES IN THE FIELD OF FAM-ily violence generate as much controversy as screening women for intimate partner violence (IPV) in health care settings. 1,2 Herein, we use the term screening to refer to universal routine inquiry: "a standardized assessment of patients, regardless of their reasons for seeking medical attention," 1 aimed at identifying women who are experiencing or have recently experienced IPV.Proponents of screening emphasize the following as a rationale for its implementation: the high prevalence of IPV and associated impairment, 3,4 the high level of acceptability among women about such inquiry, 5,6 the availability of feasible screening techniques, 7,8 and the opportunity to offer support and refer-rals to patients once IPV is identified. 6,9 Organizations such as the US Preventive Services Task Force 10 and the Canadian Task Force on Preventive Health Care 11 have concluded that insufficient evidence exists to recom-For editorial comment see p 568.

clinicaltrials.gov Identifier: NCT00336297.

No abstract

BackgroundAppropriate screening may reduce the mortality and morbidity of colorectal, breast, and cervical cancers. However, effective implementation strategies are warranted if the full benefits of screening are to be realized. As part of a larger agenda to create an implementation guideline, we conducted a systematic review to evaluate interventions designed to increase the rate of breast, cervical, and colorectal cancer (CRC) screening. The interventions considered were: client reminders, client incentives, mass media, small media, group education, one-on-one education, reduction in structural barriers, reduction in out-of-pocket costs, provider assessment and feedback interventions, and provider incentives. Our primary outcome, screening completion, was calculated as the overall median post-intervention absolute percentage point (PP) change in completed screening tests.MethodsOur first step was to conduct an iterative scoping review in the research area. This yielded three relevant high-quality systematic reviews. Serving as our evidentiary foundation, we conducted a formal update. Randomized controlled trials and cluster randomized controlled trials, published between 2004 and 2010, were searched in MEDLINE, EMBASE and PSYCHinfo.ResultsThe update yielded 66 studies new eligible studies with 74 comparisons. The new studies ranged considerably in quality. Client reminders, small media, and provider audit and feedback appear to be effective interventions to increase the uptake of screening for three cancers. One-on-one education and reduction of structural barriers also appears effective, but their roles with CRC and cervical screening, respectively, are less established. More study is required to assess client incentives, mass media, group education, reduction of out-of-pocket costs, and provider incentive interventions.ConclusionThe new evidence generally aligns with the evidence and conclusions from the original systematic reviews. This review served as the evidentiary foundation for an implementation guideline. Poor reporting, lack of precision and consistency in defining operational elements, and insufficient consideration of context and differences among populations are areas for additional research.

Management of chronic pain in IPV survivors requires attention to symptoms of PTSD, abuse-related injury, and lifetime experiences of violence. Ensuring that acute pain from injury is adequately treated and followed over time may reduce the extent of chronic pain in abused women. The results also support the importance of routine assessment for IPV and child abuse.