Literature Collection

BACKGROUND: Women veterans, compared to civilian women, are especially at risk of experiencing intimate partner violence (IPV), pointing to the critical need for IPV screening and intervention in the Veterans Health Administration (VHA). However, implementing paper-based IPV screening and intervention in the VHA has revealed substantial barriers, including health care providers' inadequate IPV training, competing demands, time constraints, and discomfort addressing IPV and making decisions about the appropriate type or level of intervention. OBJECTIVE: This study aimed to address IPV screening implementation barriers and hence developed and tested a novel IPV clinical decision support (CDS) tool for physicians in the Women's Health Clinic (WHC), a primary care clinic within the Veterans Affairs Palo Alto Health Care System. This tool provides intelligent, evidence-based, step-by-step guidance on how to conduct IPV screening and intervention. METHODS: Informed by existing CDS development frameworks, developing the IPV CDS tool prototype involved six steps: (1) identifying the scope of the tool, (2) identifying IPV screening and intervention content, (3) incorporating IPV-related VHA and clinic resources, (4) identifying the tool's components, (5) designing the tool, and (6) conducting initial tool revisions. We obtained preliminary physician feedback on user experience and clinical utility of the CDS tool via the System Usability Scale (SUS) and semistructured interviews with 6 WHC physicians. SUS scores were examined using descriptive statistics. Interviews were analyzed using rapid qualitative analysis to extract actionable feedback to inform design updates and improvements. RESULTS: This study includes a detailed description of the IPV CDS tool. Findings indicated that the tool was generally well received by physicians, who indicated good tool usability (SUS score: mean 77.5, SD 12.75). They found the tool clinically useful, needed in their practice, and feasible to implement in primary care. They emphasized that it increased their confidence in managing patients reporting IPV but expressed concerns regarding its length, workflow integration, flexibility, and specificity of information. Several physicians, for example, found the tool too time consuming when encountering patients at high risk; they suggested multiple uses of the tool (eg, an educational tool for less-experienced health care providers and a checklist for more-experienced health care providers) and including more detailed information (eg, a list of local shelters). CONCLUSIONS: Physician feedback on the IPV CDS tool is encouraging and will be used to improve the tool. This study offers an example of an IPV CDS tool that clinics can adapt to potentially enhance the quality and efficiency of their IPV screening and intervention process. Additional research is needed to determine the tool's clinical utility in improving IPV screening and intervention rates and patient outcomes (eg, increased patient safety, reduced IPV risk, and increased referrals to mental health treatment).

BACKGROUND: The shift in mental health towards ecological and collaborative models, in alignment with the recovery paradigm, has sparked interest in dialogical and coproductive practices. These practices aimed to promote epistemic justice and strengthen the therapeutic alliance. Among these, collaborative writing (cowriting) is emerging as a promising tool. However, it currently lacks a robust theoretical and methodological foundation, particularly in its integration with phenomenology and its clinical applications. This article proposes the core elements of a "phenomenological cowriting" model that seeks to frame the practice within clinical phenomenology, distinguish it from purely narrativist approaches, and highlight its unique contributions. SUMMARY: This study conducts a theoretical analysis with a focus on clinical applicability, integrating the principles of clinical phenomenology with collaborative and dialogical methods. The relevance of a phenomenological cowriting model is demonstrated through a comparative analysis with other collaborative writing approaches, such as those based on narrativist or ethnographic traditions, and is exemplified by a case vignette. From a clinical perspective, we propose a three-phase model: (1) therapeutic dialogue, (2) the use of transcription as a "textual artefact," and (3) joint rewriting. This model provides significant value in terms of process and outcomes. As a process, it embodies a collaborative care framework that minimises epistemic asymmetry and promotes patient agency. As an outcome, it helps clarify the patient's lived experience, including its prereflective dimensions, thereby enriching shared psychopathological knowledge with a first-person perspective. KEY MESSAGE: Phenomenological cowriting should be understood not as a mere technique but as a comprehensive and integrated model of care. Grounded in clinical phenomenology and the coproduction of a text, it provides a structured method for constructing therapeutic pathways that foreground an active role for the patient, ultimately generating clinical knowledge rooted in the subjective experience of suffering.