Recommendation grades (A-B-C-D-E-I) are indicated for each recommendation. These definitions are repeated following the recommendations.
Screening
Women: Due to the lack of a demonstrated link between screening and the reduction of violence outcomes, the Canadian Task Force concludes that there is insufficient evidence to recommend for or against routine screening for violence against either pregnant or non-pregnant women (I Recommendation). This is distinct from the need for clinicians to include questions about exposure to domestic violence as part of their diagnostic assessment of women. This information is important in caring for the patient, and may influence assessment and treatment of other health problems.
Men: The Task Force concludes that there is insufficient evidence to recommend for or against primary care screening of men as perpetrators of domestic violence (I Recommendation).
Interventions for Pregnant & Non-Pregnant Women
Primary Care Counseling: The Task Force concludes that there is insufficient evidence to recommend for or against counseling of abused women by primary care clinicians, although decisions to do so may be made by the clinician and patient on other grounds (I Recommendation).
Referral to Shelters: The Task Force concludes that there is insufficient evidence to recommend for or against referral to shelters, although decisions to do so may be made by the clinician and patient on other grounds (I Recommendation).
Referral to Post-Shelter Advocacy Counseling: The Task Force concludes that there is fair evidence (level I, fair) to refer women who have spent at least one night in a shelter to a structured program of advocacy services as outlined in the study by Sullivan & Bybee (Sullivan & Bybee, 1999) (B Recommendation).
Referral to Personal and Vocational Counseling: The Task Force concludes that there is insufficient evidence to recommend for or against referral to personal or vocational counseling, although decisions to do so may be made by the clinician and patient on other grounds (I Recommendation).
Interventions for Men and/or Couples
Batterer/Couples Interventions: The Task Force concludes that there is conflicting evidence regarding the effectiveness of batterer interventions (with or without partner participation) in reducing rates of further domestic violence (Dunford, 2000; Harris et al., 1988; Edelson & Syers, 1991; Brannen & Rubin, 1996; Dutton, 1986; Chen et al., 1989; Palmer et al., 1992; Saunders, 1996; Dobash et al., 1996; Gondolf, 1999; Davis & Taylor, 1999) (C Recommendation).
Grades of Recommendations for Specific Clinical Preventive Actions
A The Canadian Task Force (CTF) concludes that there is good evidence to recommend the clinical preventive action.
B The CTF concludes that there is fair evidence to recommend the clinical preventive action.
C The CTF concludes that the existing evidence is conflicting and does not allow making a recommendation for or use of the clinical preventive action, however other factors may influence decision-making.
D The CTF concludes that there is fair evidence to recommend against the clinical preventive action.
E The CTF concludes that there is good evidence to recommend against the clinical preventive action.
I The CTF concludes that there is insufficient evidence (in quantity and/or quality) to make a recommendation, however other factors may influence decision-making.
The CTF recognizes that in many cases patient specific factors need to be considered and discussed, such as the value the patient places on the clinical preventive action; its possible positive and negative outcomes; and the context and/or personal circumstances of the patient (medical and other). In certain circumstances where the evidence is complex, conflicting or insufficient, a more detailed discussion may be required.
