Domestic violence in the home is not a new issue, but it is a growing issue. Since the onset of the COVID-19 pandemic, people are spending more time indoors than ever before due to losing their jobs, needing to care for children, or working virtually from home. For women who have been living in a domestic violence environment, going to work might have been their only escape from this daily nightmare. Ironically, they now have no escape unless they get diagnosed with cancer.
We are required to ask our patients if they are in an environment that has resulted in harm to them, or if they soon will be. This of course requires a candid discussion away from the ears and eyes of others accompanying them to their appointments – people who may be the perpetrator of the violence.
It is tricky at this time to ask such questions during a telemedicine visit because you may not know who is within hearing distance in the home. You also may witness actual verbal abuse happening in the background while you are talking with your cancer patient. The violence that you witness may be against young children living in the home, too.
Because this issue is escalating, we need to be even more vigilant in screening patients. Sometimes the best opportunity is when they come in for surgery or chemotherapy, and you or a member of your multidisciplinary team is alone with the patient.
At Johns Hopkins where I work, we always do an additional screening with the patient in the preop area. When she confirms her situation, we have police ready to “pick up” her spouse/partner in the waiting area while she is transported to a safe location postoperatively, such as House of Ruth, where home health nurses visit her that evening.
There are many reasons why patients haven’t attempted to leave these risky environments up until now. One reason is simply having no place to go, another may be for financial reasons, and a third might be that they don’t know that their children can be moved to a safe place with them. They also worry that getting him out of their home will be just for a night or 2 and, when he returns, the abuse she will experience is not worth it or even gets far worse than it has been. Sadly, another reason is because they have never known any other type of environment to live in, so this abuse is “normal” to them and likely was the same type of environment they themselves grew up in.
Getting a cancer diagnosis may give a woman the needed help to end the domestic violence and experience a better life during and following cancer treatment. However, it is only possible if we ask the questions and provide the resources they have long needed.
So, be sure this assessment is being done, and being done routinely, with all new patients you are caring for. This gives the term “survivor” an all-new meaning….