A Survey of State Correctional Health Care Providers on Advance Care Planning: Opportunity for Collaboration With Corrections

Abstract

Prison populations are rapidly aging. Persons in prison age quicker and suffer more chronic illness and disability than their nonincarcerated peers, posing challenges to caring for prisoners who are chronically ill and dying. The goal of our study was to describe state prisons’ practices and policies addressing persons in prison with advanced chronic and life limiting illness through a national web-based survey of state-level prison health care professionals. In particular, we focused on advanced care planning, use of health care directives, decision-making about goals of care, including life sustaining treatments, The response rate was 22% for a sample size 152 completed surveys. The average age of respondent was 52 years; majority were female and Caucasian, and had worked in corrections more than 8 years. Nearly half were registered nurses. Most reported their prison did not have a dedicated end-of-life care program and only 11% offered a peer-care program. However, two-thirds indicated their facility provided the opportunity to designate a health care agent with physicians most likely responsible for facilitating completion of a health care directive. It is evident the care of persons aging and dying in prison is complex and requires further investigation addressing staff and prison population education, ethics guidelines for care, compassionate release, and advance care planning. This study suggests that hospice and palliative care professionals could collaborate with corrections professionals and national organizations to provide innovative education and support to enhance the humane care of this vulnerable population.

Advance Care Planning

“…The lack of routine access to ACP across US prison systems is especially concerning due to the considerable chronic disease burden experienced by people who are incarcerated and the growing older adult population in prisons 7 . A recent literature review identified 3 overarching themes describing barriers and facilitators to implementing ACP in prisons: (1) system-level factors, (2) attitudes and perceptions of staff and those living in prison, and (3) ACP knowledge and comprehension 1 .…”

“…Attitudes and perceptions of prison staff included concerns about triggering fears of dying in prison in those who are incarcerated, which impeded engagement in ACP discussions 1 . Those who are incarcerated were also reluctant to engage in ACP discussions due to lack of trust in the prison health care system 7 . Furthermore, lack of comprehension relating to ACP was another significant barrier experienced by those who are incarcerated.…”