Death and Dying in Prison: An Integrative Review of the Literature

How do people in prison access palliative care? A scoping review of models of palliative care delivery for people in prison in high-income countries

BACKGROUND

An ageing prison population with complex health needs combined with punitive sentencing practices means palliative care for incarcerated individuals is increasingly important. However, there is limited evidence regarding the models of care delivery in high-income countries, and their associated challenges and benefits.

AIM

To develop a typology of models of palliative care provision for incarcerated individuals, synthesise evidence of their outcomes and describe facilitators of and challenges in delivering different models of palliative and end-of-life care in prisons.

DESIGN

Scoping review following Arksey and O'Malley, with narrative synthesis. The protocol was registered prospectively (reviewregistry1260).

DATA SOURCES

MEDLINE, EMBASE, CINAHL, PsycINFO, the Social Sciences Citation Index and grey literature were searched on 15th March 2023. The Mixed Methods Appraisal Tool (MMAT) was used for quality appraisal.

RESULTS

A total of 16,865 records were screened; 22 peer-reviewed articles and 18 grey literature sources met the inclusion criteria. Three models were identified: Embedded Hospice, Outsourcing Care and Community Collaboration. The Embedded Hospice model shows potential benefits for patients and prisons. Outsourcing Care may miss opportunities for comprehensive care. Collaborative Care relies on proactive prison-community relationships that could be formalised for improvement. Psychosocial and bereavement needs of those dying in prison and their caregivers lack sufficient documentation.

CONCLUSION

Further research is needed to evaluate prison hospice costs and examine how prison hospices impact compassionate release usage. Beyond the USA, policies might formalise care pathways and recognise best practices. Further investigation to address psychosocial needs of people in prison with life-limiting illnesses and post-death bereavement support is required.

Caring for people in prison with palliative and end-of-life care needs

PURPOSE OF REVIEW

The prison population is growing and ageing, and many people will die from natural causes while incarcerated. This article provides a contemporary review of key issues related to palliative and end-of-life care in prisons.

RECENT FINDINGS

Few countries have integrated prison hospices. Palliative care needs may go unrecognised in prison. Older offenders may not trust the prison to care for them and may benefit from segregation. Cancer remains a major cause of death. Training staff remains a priority, and technology can help facilitate this. The coronavirus disease 2019 (COVID-19) had a significant impact on prisons, less is known about its impact on palliative care. Compassionate release is underutilised, and the issue of medically assisted dying adds complexity to decisions around end-of-life care. Peer carers can provide reliable symptom assessment. Family members are often absent when someone dies in prison.

SUMMARY

Palliative and end-of-life care in prisons requires a joined-up approach, and staff must understand the challenges of both this and custodial care in general. The relational network both inside and outside of the prison should be involved, and when possible and appropriate, we should consider alternatives to dying whilst incarcerated, such as compassionate release.

Developing a typology of models of palliative care delivery in prisons in high-income countries: protocol for a scoping review with narrative synthesis

INTRODUCTION

A combination of punitive sentencing practices within ageing populations, compounded by the health challenges faced by people in prison, means that dedicated palliative care provision within prisons is a pressing requirement. However, evidence about exactly how quality palliative and end-of-life care is delivered in this environment remains sparse.This review aims to develop a typology of models of palliative and end-of-life care delivery within prisons in high-income countries to inform service development and policy.

METHODS AND ANALYSIS

We will conduct a scoping review of published studies and grey literature, following the Arksey and O'Malley framework. We will report data on models of palliative and end-of-life care delivery in prisons in high-income countries. Searches will be undertaken in Medline, EMBASE, CINAHL, Social Sciences Citation Index and PsyINFO for all study types, published from 1 January 2000 to December 2021, and reference lists from key reviews and studies will be screened for additional references. We will also screen grey literature from within other high-income countries using a targeted search strategy. For published reports of original research, study quality and risk of bias will be assessed independently by two reviewers using the Mixed Methods Appraisal Tool. A narrative synthesis of the data will be undertaken, integrating the results of the quality assessment.

ETHICS AND DISSEMINATION

Approval by research ethics committee is not required since the review only includes published and publicly accessible data. We will publish our findings in a peer-reviewed journal as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidance.

PROTOCOL REGISTRATION

The final protocol was registered with the Research Registry on 26 November 2021 (www.researchregistry.com).Unique ID number: reviewregistry1260.