Lewis-O'Connor Annie, Warren Abi, Lee Jeannie V, Levy-Carrick Nomi, Grossman Samara, Chadwick Mardi, Stoklosa Hanni, Rittenberg Eve
1 Brigham and Women's Hospital, Boston, MA, USA.
2 Harvard Medical school, Boston, MA, USA.
Womens Health (Lond). 2019 Jan-Dec;15:1745506519861234. doi: 10.1177/1745506519861234.
Within the context of longitudinal medical care for adults, health care providers have a unique opportunity to inquire and respond to the traumatic life experiences affecting the health of their patients, as well as a responsibility to minimize retraumatizing these patients during medical encounters. While there is literature on screening women for intimate partner violence, and there is emerging data on pediatric screening for adverse life experiences, there is sparse literature on inquiry of broader trauma histories in adult medical settings. This lack of research on trauma inquiry results in an absence of guidelines for best practices, in turn making it challenging for policy makers, health care providers, and researchers to mitigate the adverse health outcomes caused by traumatic experiences and to provide equitable care to populations that experience a disproportionate burden of trauma. This state of the science summarizes current inquiry practices for patients who have experienced trauma, violence, and abuse. It places trauma inquiry within an anchoring framework of trauma-informed care principles, and emphasizes a focus on resilience. It then proposes best practices for trauma inquiry, which include tiered screening starting with broad trauma inquiry, proceeding to risk and safety assessment as indicated, and ending with connection to interventions.
在为成年人提供纵向医疗服务的背景下,医疗服务提供者有独特的机会去询问并应对影响患者健康的创伤性生活经历,同时也有责任在医疗问诊过程中尽量减少对这些患者造成二次创伤。虽然有关于筛查女性亲密伴侣暴力的文献,也有关于儿科不良生活经历筛查的新数据,但关于在成人医疗环境中询问更广泛创伤史的文献却很少。这种对创伤询问研究的缺乏导致缺乏最佳实践指南,进而使得政策制定者、医疗服务提供者和研究人员难以减轻创伤经历造成的不良健康后果,并为遭受不成比例创伤负担的人群提供公平的医疗服务。本科学现状总结了针对经历过创伤、暴力和虐待患者的当前询问实践。它将创伤询问置于创伤知情护理原则的锚定框架内,并强调关注复原力。然后提出了创伤询问的最佳实践,包括从广泛的创伤询问开始的分层筛查,根据需要进行风险和安全评估,并以与干预措施的联系结束。