Background: Despite rapidly aging populations in prisons and jails, evidence suggests that advance care planning (ACP), an essential component of geriatric care, is not widely conducted in correctional healthcare settings. Objectives: Investigate correctional health care providers’ ACP knowledge and experience, their perspectives on barriers to ACP in correctional settings and how to overcome those barriers. Design: Qualitative Study Setting: Four prisons across two states and one large city jail in a third state. Participants: 24 correctional healthcare providers (e.g. physicians, nurses, social workers) participated in individual semi-structured phone interviews about ACP in correctional settings. Results: Participants demonstrated low baseline ACP knowledge; 85% reported familiarity with ACP, but only 42% provided accurate definitions of ACP. Fundamental misconceptions included the belief that ACP was done by providers without soliciting patient input. Multiple ACP barriers were identified, many of which are unique to prison and jail facilities, including provider uncertainty about the legal validity of ACP documents in prison/jail, patient mistrust of the correctional healthcare system, patients’ isolation from family/friends, and institutional policies that restrict use of ACP. Clinicians’ suggestions for overcoming those barriers included ACP training for clinicians, creating psychosocial support opportunities for patients, revising policies that limit ACP, and systematically integrating ACP into healthcare practice. Conclusion: Despite an increasing number of older and seriously ill patients in prisons and jails, many correctional healthcare providers lack knowledge about ACP. In addition to ACP barriers found in the community, unique barriers to ACP exist in prisons/jails. Future research and policy innovation are needed to develop clinical training programs and identify ACP implementation strategies for use in correctional settings.

Background: Wnt5a signaling induces asymmetric localization of the melanoma cell adhesion molecules (MCAM). Results: Wnt5a promotes MCAM depalmitoylation and point mutations in MCAM that block palmitoylation are sufficient to cause asymmetric MCAM localization. Conclusion: Wnt5a induces polarized MCAM localization by promoting MCAM depalmitoylation. Significance: These results reveal a mechanism for Wnt5a-induced polarized cell behavior.

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