The Domestic Abuse and Life-Limiting Illness (DALLI) toolkit: a resource for managing uncertainty in the domestic abuse and palliative care context

Uncertainty is a fundamental aspect of the role of palliative care professionals, manifesting in the management of complex physical, social and psychosocial care needs. While considerable attention has been given to clinical uncertainty the uncertainty palliative care professionals encounter, and are required to navigate, when faced with a lack of predictability, complexity, lack of information, knowledge, understanding or unfamiliarity as part of wider patient care has been under-investigated. This is particularly the case in the domestic abuse and life-limiting illness context where uncertainty and risk are magnified for both patients experiencing abuse and healthcare providers tasked with identifying and responding to it. <br/><br/>We report findings from the novel DALLI study which explored domestic abuse and life-limiting-illness and findings from which informed development of the DALLI Toolkit, with and for, hospice and palliative care professionals. <br/>A 36-month mixed-method study was conducted comprising a survey to map service provision (n=48), qualitative interviews (n=18) and five community of practice workshops (n=16) with health and social care professionals, local authority domestic abuse services, specialist domestic abuse organisations, and victim-survivors. Interview and community of practice findings are presented here.<br/><br/>Findings showed palliative care practitioners recognised their role in supporting victim-survivors but reported a lack of knowledge and confidence. Recognising signs of abuse due to the presence of co-morbidities, which mask indicators or overlap with the dying process, and assessing relationship dynamics amidst complex emotions of life-limiting-illness contributed to practitioners’ uncertainty, as did concerns about jeopardising the therapeutic relationship with the patient and family. In palliative care settings using the DALLI Toolkit, professionals reported increased understanding of domestic abuse and confidence to identify and respond to disclosures. <br/><br/>Implementing the DALLI Toolkit offers a mechanism for minimising uncertainty, reducing risk, and increasing patient wellbeing and safety in the domestic abuse and life-limiting illness context.<br/>