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White Book

About this guideline

Abuse and violence: working with our patients in general practice, 5th edition (the White Book), was developed by general practitioners (GPs) and subject matter experts to ensure that the content is the most valuable and useful for health practitioners. The guideline is a practical resource and is based on the best-available current evidence.

The update of the White Book was supported with funding from the Australian Government Department of Health.

All chapters in the 5th edition have been updated with new guidance based on the latest evidence. This edition has been expanded to include six new chapters:

  • Supporting men who experience intimate partner abuse and violence
  • Trauma-informed care in general practice
  • Adolescent-to-parent violence
  • Dating violence and technology-facilitated abuse
  • LGBTIQA+ family abuse and violence
  • Intimate partner abuse and violence: Education and training for healthcare professionals

In this edition, the term ‘victim/survivor’ is used for patients who experience abuse and violence, and ‘perpetrator’ for patients who use abuse and violence (although we acknowledge these terms are not always preferred by some people). 

Chapters are presented under six topics:

  • ‘Domestic’ or intimate partner abuse/violence
  • Trauma- and violence-informed care
  • Children and young people
  • Specific abuse issues for adults and older people
  • Specific populations
  • System issues

The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used in the development of this guideline. The RACGP commissioned the Safer Families Centre of Research Excellence at the University of Melbourne to conduct the evidence review and update the evidence base.

A systematic search of the literature was conducted for each clinical question. The results are presented in GRADE ‘summary of findings’ tables. These tables provide a synthesis of findings along with a rating of certainty of evidence (also referred to as quality or confidence in evidence) and clinical importance.

‘Summary of findings’ tables were presented to the Expert Advisory Group and relevant chapter authors to move from the synthesised research evidence to formulate practice recommendations. All relevant research findings are considered in the formulation of recommendations. Additional research findings (eg qualitative, quantitative and/or mixed method) and practice consensus were also considered, where possible, when formulating recommendations and ensuring transparent and practice-based recommendations.

The technical report of evidence reviews and summary of findings contains further information on the evidence review, a description of the methods, assessment of the risk of bias, data extraction, synthesised results per outcome, a ‘summary of findings’ table per clinical question, including a rating of certainty in the evidence, and additional relevant findings, which complement the GRADE process.

The GRADE process provides a system for classifying the certainty of the overall body of evidence into:

  • High: Additional research is unlikely to change confidence in the estimate of a treatment effect
  • Moderate: Additional research will impact on confidence in the estimate and could change this estimate.
  • Low: Additional research is very likely to change the estimate
  • Very low: Any estimate of a treatment effect is uncertain

The GRADE approach is then used to rate the quality of the evidence and inform strength of recommendations:

Recommendation Description
Strong recommendation for the intervention The working group is very confident the benefits of an intervention clearly outweigh the harms (or vice versa)
Strong recommendation against the intervention The working group is very confident that the harms of an intervention clearly outweigh the benefits
Conditional recommendation for the intervention Denotes uncertainty over the balance of benefits, such as when the evidence quality is low or very low, or when personal preferences or costs are expected to impact the decision, and as such refer to decisions where consideration of personal preferences is essential for decision-making
Conditional recommendation against the intervention Denotes uncertainty over the balance of harms, such as when the evidence quality is low or very low, or when personal preferences or costs are expected to impact the decision, and as such refer to decisions where consideration of personal preferences is essential for decision-making

Practice point

Where there was insufficient evidence to formulate a recommendation, the considered opinions based on the clinical experience of experts on the Expert Advisory Group and chapter authors were used. These are referred to as a ‘practice point’, based on the consensus of experts.

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Related documents

  WhiteBook Technical Report (PDF 1.02 MB)

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