Improving domestic violence screening at Stanford: A Q&A

Photo by Kevin Lee

As part of the Clinical Observation and Medical Transcription fellowship at Stanford, Laurel Sharpless wanted to pursue a project that was personally important to her: intimate partner violence.

Her own experience with intimate personal violence during high school temporarily derailed her career plans of attending a four-year college and then medical school. So she knows how important it is to identify victims early and connect them with help.

During the fellowship — a one-year program that trains prospective health professionals to work as certified medical scribes alongside faculty physicians — Sharpless also looked at how to improve screening for intimate partner violence at Stanford clinics.

Now a San Francisco 49ers cheerleader, a clinical trials coordinator for Stanford immunology and rheumatology and a chief scribe for the COMET fellowship, Sharpless’ own dream is back on track.

I spoke with her recently about her work:

Why is it important for health care workers to screen for domestic violence?

“Intimate partner violence (IPV) is a silent epidemic affecting 1 in 3 women during their lifetime. It leads to injuries and death from physical and sexual assault, sexually transmitted infections, post-traumatic stress disorder, depression, substance abuse, suicide and many other health issues.

We need to promote intervention. This is a public health issue, and primary care and ob/gyn are the best portals for sharing that information. Otherwise, victims might not be aware of the resources they have.”

What are the barriers?

“Although the U.S. Preventive Services Task Force recommends physicians screen women of childbearing age for IPV, rates of screening in primary care settings are low. Physicians have limited time with the patient in the exam room and they have a lot to juggle when coordinating patients’ care. There is also a stigma around the topic with many patients and physicians feeling uncomfortable with the subject.”

What did you study and what did you find?

“I conducted a retrospective chart review at the five Stanford primary care clinics to understand how we were screening patients for intimate partner violence. Some clinics had medical assistants screen and others relied on the physicians alone, and I found a wide variation in screening rates.

Our study supports the national trend that medical staff should do the initial screening, and then physicians should counsel patients who screen positive and then refer them to a social worker and local victims resources.

I presented these results to the medical directors of primary care, which led to an initiative to standardize the way Stanford primary care and ob/gyn screen patients for IPV. I even got to choose the screening question we use. We now ask, ‘Because difficult relationships can cause health problems, we are asking all of our patients the following question: Does a partner, or anyone at home, hurt, hit, or threaten you?'”

What ‘s next?

 “My study results have just been accepted for publication.

I’m currently applying to medical school in hopes of becoming a physician. The COMET fellowship has really peaked my interest in primary care, but I’m going in with an open mind.

As a physician, I wish to become a champion of women’s health care, conducting research and seeing patients. I’ve seen the difference I can make in the quality of care provided to patients. I also aspire to teach the next generation of health care workers and the community at large through advocacy and education from the perspective of an academic physician.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

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Genomic screening may help predict breast cancer survival

Photo by 3dman_eu

Breast cancer patients are often faced with a difficult decision at the end of their primary treatment: Should they get systemic adjuvant therapy, such as the anti-estrogen drug tamoxifen? Such therapies lower the risk that the cancer will come back, but they also carry the risk of potentially serious side effects.

What would be helpful is for physicians to have a way to predict which patients have the best prognosis and might not need adjuvant therapy. Now, researchers from the Lawrence Berkeley National Laboratory may have a solution, according to a study recently published in Oncotarget.

The research team analyzed clinical patient data and large genomic datasets of normal and tumor breast tissues — identifying 381 genes associated with the relapse-free survival of breast cancer patients. With further analysis, they were able to develop a scoring system based on a 12-gene signature that predicts breast cancer survival. Patients with a low score were more likely to live longer.

Senior author Antoine Snijders, PhD, a research scientist at Berkeley Lab, explained in a recent news release:

“Distinguishing patients with good prognosis could potentially spare them the toxic side effects associated with adjuvant therapy. Determining prognosis involves a range of other clinical factors, including tumor size and grade, the degree to which the cancer has spread, and the age and race of the patient. Our scoring system was predictive of survival independent of these other variables.”

The study showed that their 12-gene signature was effective at predicting patient survival for two specific subtypes of breast cancer — luminal-A and HER2 — but it wasn’t effective for other subtypes.

In addition, the researchers identified seven genes as potential tumor suppressors that could be targeted when developing new breast cancer therapies. They hope that their work will help doctors and patients make more informed treatment decisions, as well as help others develop better breast cancer drugs.

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Education reduces anxiety about mammography

Woman received mammogram (Rhoda Baer)
Woman receives mammogram (Rhoda Baer)

My close childhood friend Kelly died from breast cancer when she was only 32 years old. This inspired me to choose a research position at Berkeley Lab to help develop new breast-imaging scanners to improve early detection. Given my expertise in this field, my friends come to me with their confusion and ask, “At what age and how frequently should I get a mammogram?”

There has been a lot of debate surrounding mammography screening since 2009 when the United States Preventive Services Task Force revised their guidelines for average-risked women, limiting routine screening to biennial mammography for women 50 to 74 years of age.

The task force recommended increasing the screening age in part due to the harmful anxiety caused by false-positive results, which are more common in younger women. The American Cancer Society recently released a new set of guidelines that recommends yearly mammograms starting at age 45, but they also considered the pain, anxiety and other potential side effects of mammography.

A recent article published in the Journal of the American College of Radiology describes a successful intervention to reduce this anxiety. The authors provided interactive one-hour educational sessions on mammography, which were led by a trained breast radiologist.

Before the lecture, a questionnaire was administered to the participants to identify their anxiety and previous mammography experience — 117 responded. Those respondents who reported having anxiety about mammography screening indicated “unknown results” and “anticipation of pain” as the primary sources of their anxiety.

A follow-up questionnaire measured the effectiveness of the informational sessions. Virtually all participants were able to correctly answer key facts that were covered in the lecture, such as recognizing that it is important to have your prior mammogram available to the radiologist for comparison.

The journal article concludes:

Attendees of these sessions reported high levels of satisfaction in their participation, with a strongly favorable impact on increased knowledge and decreased anxiety (“harm”). Education can enable women to share in informed decision making regarding if, when, and how often to attend screening mammography. Attendees also reported encouragement to attend screening mammography.

The authors hope to encourage other radiologists to provide similar proactive, public outreach education.

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.