Overview

Domestic abuse affects almost 9 million of us in England and Wales and is a violation of basic human rights and a form of gender-based violence. Its impact on mental and physical health is profound and long-lasting. Evidence from the USA shows that the impact extends to screening, care, and treatment for cancer. Healthcare professionals are often the first or only professionals to whom victim-survivors disclose domestic abuse. Interventions have transformed the healthcare response to domestic abuse in a range of clinical practice areas. But no interventions have been conducted and evaluated within the UK’s cancer workforce. This is an enormous gap in knowledge and practice.

This presentation outlined the results of a consultation exercise that explored what is currently happening in the cancer workforce and why with regards to the identification and response to domestic abuse. The consultation used surveys and interviews with professionals who see patients diagnosed with cancer, reaching over 300 professionals from mostly acute or community health, and victim-survivors of domestic abuse affected by cancer. The findings will lay the groundwork for an intervention that aims to improve the confidence and awareness of cancer professionals around domestic abuse and ensure that victim-survivors get the support they need.

This work is led by Standing Together Against Domestic Abuse and is funded by Macmillan Cancer Support.

Recap

During the talk Sandi confirmed that victim-survivors of domestic abuse noticed a change in the level of abuse they suffered after receiving a positive cancer diagnosis. A cancer diagnosis means a victim has to rest more and seek professional advice and support. During this time abusers changed their dynamics and worsened their abuse to make up for their loss of control over the victim-survivor.

“He was scared that if I was ill, I wouldn’t be able to fund his lifestyle.”

A diagnosis of cancer gave abusers the opportunity to use forms of abusive behaviour they had not used previously, such as physical threats, control of children, and degrading victim-survivors. Some patients had to rely on their abusers for support with childcare and other practicalities, such as travel to and from appointments.

“He went into screaming fits, swearing at me for hours in the car while driving me to/from hospital”.

“Having to turn to my abuser for help during my cancer treatment, after spending years trying to escape the abusive relationship, was the number one source of stress and fear.”

Abusers acted in ways that affected treatment, surgery and recovery, for example by not allowing victim-survivors to relax or recover, undermining or ridiculing treatment or support choices, making victim-survivors feel bad about the way they looked after treatment, and abusing them in front of care professionals.

Most professionals agree they have a responsibility for domestic abuse and to support patients who experience it, and there are a number of key points at which clinicians could intervene or the victim could ask for help. Of the professional responses received, 50% had come across cases of domestic abuse in the past three years.

Common barriers to disclosing abuse to cancer professionals include believing that it isn’t the cancer professional’s role to intervene, feelings of guilt and shame, and abuse not being seen as a priority compared to cancer care.

Cancer professionals reported making a range of referrals over three years, including 42 referrals for specialist domestic abuse support; some responded that referrals weren't made due to services already being over-capacity. Confidence hindered a professional’s ability to identify and respond; a third did not feel confident in recognising signs of physical, sexual emotional or psychological abuse, and under half did not feel confident recognising financial abuse. 

Victim-survivors would like professionals to be aware of the signs of domestic abuse, ensure that the cancer setting is safe for disclosure, recognise mental and physical health consequences of domestic violence, and refer or signpost patients to specialist support. 

Professionals are keen to undergo focussed training that will help them recognise the sings of abuse, shatter stereotypes about typical victims, and be provided with practical resources and information about helplines and support services. A culture shift where domestic abuse is everyone’s responsibility is required.

Next steps

What is a safe and best practice response towards victim-survivors with cancer? Once identified, these findings will be shared and disseminated via a toolkit. 

Read Sandi's report, published by Macmillan Cancer Support

Watch the recording