CONCLUSION: VI appears to have clinical advantages of greater underlying consistency and continuity of care, but does not appear associated with early (acute) rehab intervention. Shortterm mortality does not appear to be associated with VI, but other outcome measures such as functional recovery may be more sensitive and appropriate. As trends towards vertical integration continue, a better understanding of VI's clinical impact is imperative. PURPOSE: One barrier to screening and disclosure of Intimate Partner Violence (IPV) is the patient's lack of trust in their health care provider. The objective of this study was to identify characteristics that facilitate trust in the patient-provider relationship among survivors of IPV. METHODS: Qualitative data were collected using semi-structured, open-ended interviews with a sample of 28 female survivors of IPV. Participants were recruited from community-based IPV organizations in the Boston area. A one hour face-to-face interview explored the woman's beliefs and attitudes about trust in her interactions with health care providers. Interviews were audiotaped and transcribed. Using Grounded Theory Methods, the transcripts were analyzed for significant themes, from which a conceptualization of trust was developed. RESULTS: Among the participants, ages ranged from 18 to 56, 36% were Black, 32% Hispanic and 18% white. All suffered physical violence, but only 60% ever sought medical care as a result. We identified five dominant concepts that described dimensions of provider behavior on which trust was based: 1) OPEN COMMUNICATION Ð listening to patients and keeping them well informed of their medical condition; 2) PROFESSIONAL COMPETENCY Ð appearing knowledgeable, performing thorough medical evaluations and being familiar with the medical and social histories; 3) PERSONAL COMMITMENT Ð being consistently accessible, both physically and emotionally (``always been there for me''), respecting confidentiality, spending ample time with participants and demonstrating personal concern outside the traditional provider role; 4) EMOTIONAL SAFETY Ð sharing personal information and establishing a climate of safety for the participants through nonjudgmental and compassionate gestures (``he had tears in his eyes'') or comforting nonverbal mannerisms; 5) EMPOWERMENT Ð promoting self-efficacy and shared decision-making. Gender and ethnic characteristics of the providers had variable effects on trust. CONCLUSION: These survivors of IPV reported several aspects of provider behavior that facilitate trust in their clinical relationship, including open and explicit communication, professional competence, personal commitment, establishing a safe emotional environment and patient empowerment. Strengthening these provider behaviors may increase trust with patients and thus improve screening and disclosure of IPV. PURPOSE:``Turfing'' is the transfer or triage of a patient to a physician for reasons the receiving physician deems inappropriate.``Turfing'' has been identified as a troubling source of professional and ethical conflict for housestaff and medical students. Prior work has reported that``turfed'' patients have a worse hospital experience than appropriately transferred patients. We wondered whether attendings' perceptions of``turfing'' supported patients' perspectives. METHODS: One trained research assistant conducted in-depth, semi-structured, open-ended individual interviews with a convenience sample of 16 attending physicians from internal medicine, emergency medicine and general surgery. The interviews were meant to elicit attendings' views on the quality of``turfed'' patients' care as well as other dimensions of this triage phenomenon. Audiotapes of interviews were subjected to content and thematic analysis. Results presented here include only attendings' comments about the quality of``turfed'' patients' care. RESULTS: All attendings interviewed in emergency medicine (n=4) and general surgery (n = 4) felt that``turfed'' patients received inferior care. Of the 8 internal medicine attendings interviewed, 5 felt``turfed'' patients received inferior care, 1 was equivocal, and 2 did not comment on this specific issue. Subjects considered quality of care to include length of stay, interpersonal interactions between patients and housestaff, and delays in management plans and bed assignments. Subjects stated:``There is always hostility toward the patient from the housestaff in these situations If you go watch [the housestaff] and see how they interact with the patient, they are abrupt with them, dismissive toward them.''``Patients are put in harm's way.''` [ Housestaff] probably don't take as inquisitive an approach [to history-taking] which is not in the patient's best interest.''``We avoid people who have been in the ED for too long [because no one will accept them on their service].'' Three themes emerged as causes for this inferior care: lack of``ownership'' of``turfed'' patients by physicians, the transient nature of physician relationships with``turfed'' patients, and feelings that``turfs'' are unwanted. CONCLUSION: Attendings' interviews substantiate that the care of``turfed'' patients suffers. Interviewees recommended remedies for these troubling findings, such as stronger moral leadership from department chairs and improved role modeling by clinical faculty. The purpose of this pilot study was to determine whether there are differences in the way Caucasians and African Americans would present facts about prostate cancer screening in a culturally appropriate brochure to men considering screening. Because screening with prostate specific antigen (PSA) is controversial, several professional organizations recommend informing men about the risks and benefits of screening. Compared to Caucasians, African Americans have a higher risk for prostate cancer and are less knowledgeable about screening. In a previous study, experts in prostate cancer and Caucasian and African American couples with screened and unscreened men identified 17 key facts about PSA they believe men ought to know. METHODS: We convened a focus group of 5 African American couples and a focus group of 5 Caucasian couples who each met twice. At the first meeting couples viewed a videotape about prostate cancer and screening and were asked to discuss how to present the 17 key facts in a culturally-sensitive way in terms of content and format. Mock ups of brochures were developed for discussion at the second meeting. We analyzed transcripts of the focus group meetings using content analysis to identify differences between African American and Caucasian groups in how to present this information. RESULTS: We found differences in content emphasis and in graphic design choices between the brochures that African Americans and Caucasians would design for members of their racial/ethnic group. Because of the perceived discomfort and embarrassment associated with the digital rectal exam (DRE), African American men felt strongly that it was important to emphasize the advantages and disadvantages of screening with the DRE, as well as the PSA. Caucasian men did not discuss the DRE at all. African Americans believed it was important to emphasize epidemiologic data specific to African American men, such as their higher risk of prostate cancer. They also preferred images and symbols rooted in African American culture (e.g. Kente cloth). CONCLUSION: African Americans and Caucasians differed in the way they chose to present facts about prostate cancer screening to members of their racial/ethnic group. Cultural differences in format and content need to be considered when designing educational materials such as brochures.