Evidence
Overview of 2018 surveillance methods
Overview of 2018 surveillance methods
NICE's surveillance team checked whether recommendations in domestic violence and abuse: multi-agency working (NICE guideline PH50) remain up to date.
The surveillance process consisted of:
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Initial feedback from topic experts via a questionnaire.
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Input from stakeholders on known variations in practice and policy priorities.
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Literature searches to identify relevant evidence.
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Assessing the new evidence against current recommendations and deciding whether or not to update sections of the guideline, or the whole guideline.
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Consulting on the decision with stakeholders, except if we propose to update and replace the whole guideline.
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Considering comments received during consultation and making any necessary changes to the decision.
For further details about the process and the possible update decisions that are available, see ensuring that published guidelines are current and accurate in developing NICE guidelines: the manual.
Evidence considered in surveillance
Search and selection strategy
We searched for new evidence related to the whole guideline.
We found 23 studies in a search for randomised controlled trials and systematic reviews published between 11 May 2012 and 16 April 2018.
See appendix A: summary of evidence from surveillance for details of all evidence considered, and references.
Ongoing research
We checked for relevant ongoing research; of the ongoing studies identified, 2 studies were assessed as having the potential to change recommendations; therefore we plan to regularly check whether these studies have published results, and evaluate the impact of the results on current recommendations as quickly as possible. These studies are:
Intelligence gathered during surveillance
Views of topic experts
We sent questionnaires to 16 topic experts and received 6 responses. The topic experts either:
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participated in the guideline committee who developed the guideline
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were recruited to the NICE Centre for Guidelines Expert Advisers Panel to represent their specialty
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work at Public Health England with a specialty in domestic violence and abuse; or
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were identified as a key voluntary or community sector organisation working with victims or perpetrators of domestic violence and abuse.
The general consensus of the topic experts was to update the guideline by including links and references to newly published policies and resource toolkits in relation to domestic violence and abuse. However, the guideline should maintain its broad spectrum of recommendations on the planning and delivery of services for domestic violence and abuse. To this end, it would not link or reference specific external resources and instead allow commissioners to plan and map services according to local and regional needs.
Views of stakeholders
Stakeholders are consulted on all surveillance decisions except if the whole guideline will be updated and replaced. Because this surveillance decision was to not update the guideline, we consulted on the decision.
Overall, 6 stakeholders commented. Five agreed with the decision to not update the guideline and 1 disagreed with the decision.
Several comments suggested that although there is some new evidence relevant to the guideline, this is insufficient to impact the recommendations at this time. Stakeholders generally agreed that these new studies, along with current ongoing trials, should be considered again at the next surveillance review of NICE guideline PH50.
The stakeholder who disagreed with the decision to not update the guideline commented that systemic therapy should be considered for inclusion in the recommendations. However, the surveillance review did not find any evidence on the effectiveness of systemic therapy for domestic violence and abuse.
A stakeholder commented that there is difficulty applying the guideline in the health community and in services under local authority control. However, the surveillance review did not find any data to ascertain the level of implementation or any evidence on improving the uptake of recommendations. NICE guideline PH50 does recommend a multi-agency approach to creating and providing services, although how this is applied would be based on local service structures and need. Also, the NICE website includes shared learning resources that provide examples of how NICE guideline PH50 has been used in practice.
Several stakeholders commented on the gender-neutral wording contained within some of the recommendations. Some stakeholders agreed that keeping the guideline gender-neutral encourages inclusivity and increases the application across a wider population. Although, it was also recognised by stakeholders and the surveillance review that the majority of the evidence on domestic violence focusses on female victims. This imbalance in the evidence base was considered by the committee who developed the guideline and it was agreed at the time to extend the recommendations to create a gender-neutral guideline. Any new evidence on gender-specific interventions for victims or perpetrators of domestic violence should be assessed again at the next surveillance review.
A stakeholder also commented that many potential perpetrators of domestic violence with behavioural or other problems have initially accessed services where anger, violence and relationships were not explored or addressed. The surveillance review did not find any evidence to suggest a link between unresolved issues or behaviours and perpetration of domestic violence. Also, identifying risk factors for potential perpetration of domestic violence is beyond the scope of the guideline as the guideline is focussed on responding to domestic violence.
A stakeholder commented that digital abuse is an area not mentioned in the guideline. Digital domestic violence and abuse or cyber bullying would fall within the scope of this guideline, however, the surveillance review did not find any evidence on prevention activities that address cyber bullying. This is an area that will continue to be considered at the next surveillance review to determine the impact of any new evidence.
See appendix B for full details of stakeholders' comments and our responses.
See ensuring that published guidelines are current and accurate in developing NICE guidelines: the manual for more details on our consultation processes.
Editorial amendments
During surveillance of the guideline we identified the following points in the guideline that should be amended.
Recommendation 10 in NICE guideline PH50 should make the following cross-referral:
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For children and young people who have been exposed to domestic violence see NICE's guideline on child abuse and neglect.
Recommendation 15 in NICE guideline PH50 should make the following cross-referral:
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For pregnant women who experience domestic violence see NICE's guideline on pregnancy and complex social factors: a model for service provision for pregnant women with complex social factors.
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