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Gilbert E, Viggiani ND, de Sousa Martins J, Palit T, Sears J, Knights D, Roulston A, Turner M, Selman LE. 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. Palliat Med 2024; 38:517-534. [PMID: 38623718 PMCID: PMC11107131 DOI: 10.1177/02692163241242647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
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.
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Affiliation(s)
- Emma Gilbert
- Palliative and End of Life Care Research Group, Bristol Medical School, University of Bristol, Bristol UK
| | - Nick De Viggiani
- School of Health and Social Wellbeing, Unversity of the West of England, UK
| | - Joana de Sousa Martins
- Palliative and End of Life Care Research Group, Bristol Medical School, University of Bristol, Bristol UK
| | - Tanuka Palit
- Academic Clinical Fellow Centre of Academic Primary Care, Bristol Medical School, University of Bristol, UK
| | | | | | - Audrey Roulston
- Professor of Social Work in Palliative Care, School of Social Sciences, Education and Social Work Queen’s University, Belfast, UK
| | - Mary Turner
- Reader in Health Services Research, University of Huddersfield, Huddersfield, UK
| | - Lucy E Selman
- Palliative and End of Life Care Research Group, Bristol Medical School, University of Bristol, Bristol UK
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Shalev D, Brenner K, Carlson RL, Chammas D, Levitt S, Noufi PE, Robbins-Welty G, Webb JA. Palliative Care Psychiatry: Building Synergy Across the Spectrum. Curr Psychiatry Rep 2024; 26:60-72. [PMID: 38329570 DOI: 10.1007/s11920-024-01485-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 02/09/2024]
Abstract
PURPOSE OF REVIEW Palliative care (PC) psychiatry is a growing subspecialty focusing on improving the mental health of those with serious medical conditions and their caregivers. This review elucidates the current practice and ongoing evolution of PC psychiatry. RECENT FINDINGS PC psychiatry leverages training and clinical practices from both PC and psychiatry, addressing a wide range of needs, including enhanced psychiatric care for patients with serious medical illness, PC access for patients with medical needs in psychiatric settings, and PC-informed psychiatric approaches for individuals with treatment-refractory serious mental illness. PC psychiatry is practiced by a diverse workforce comprising hospice and palliative medicine-trained psychiatrists, psycho-oncologists, geriatric psychiatrists, other mental health professionals, and non-psychiatrist PC clinicians. As a result, PC psychiatry faces challenges in defining its operational scope. The manuscript outlines the growth, current state, and prospects of PC psychiatry. It examines its roles across various healthcare settings, including medical, integrated care, and psychiatric environments, highlighting the unique challenges and opportunities in each. PC psychiatry is a vibrant and growing subspecialty of psychiatry that must be operationalized to continue its developmental trajectory. There is a need for a distinct professional identity for PC psychiatry, strategies to navigate administrative and regulatory hurdles, and greater support for novel clinical, educational, and research initiatives.
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Affiliation(s)
- Daniel Shalev
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, 525 East 68thStreet, Box 39, New York, NY, 10065, USA.
| | - Keri Brenner
- Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Rose L Carlson
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, 525 East 68thStreet, Box 39, New York, NY, 10065, USA
| | - Danielle Chammas
- Department of Medicine, University of California: San Francisco, San Francisco, CA, USA
| | - Sarah Levitt
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Paul E Noufi
- Department of Medicine, Georgetown University, Baltimore, MD, USA
| | | | - Jason A Webb
- Department of Medicine, Oregon Health and Sciences University, Portland, OR, USA
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3
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O'Conner-Von S, Shlafer R, Galchutt P, Kettering S, Bouterse A, Freese R, Berry P. A Survey of State Correctional Health Care Providers on Advance Care Planning: Opportunity for Collaboration With Corrections. Am J Hosp Palliat Care 2024:10499091241226638. [PMID: 38279955 DOI: 10.1177/10499091241226638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024] Open
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.
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Affiliation(s)
| | - Rebecca Shlafer
- University of Minnesota Medical School, Minneapolis, MN, USA
| | | | | | - Ali Bouterse
- University of Minnesota, Social Sciences, Minneapolis, MN, USA
| | - Rebecca Freese
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
| | - Patricia Berry
- University of Utah College of Nursing, Salt Lake, UT, USA
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4
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McParland C, Johnston B, Ouwehand IEI. Caring for people in prison with palliative and end-of-life care needs. Curr Opin Support Palliat Care 2023; 17:224-230. [PMID: 37399538 DOI: 10.1097/spc.0000000000000661] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
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.
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Affiliation(s)
- Chris McParland
- School of Medicine, Dentistry and Nursing, University of Glasgow
- NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK
| | - Bridget Johnston
- School of Medicine, Dentistry and Nursing, University of Glasgow
- NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK
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5
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Schaefer I, Heneka N, DiGiacomo M, Panozzo S, Phillips JL. The importance of developing palliative care quality indicators for the prison setting: why now, and next steps. BMC Palliat Care 2023; 22:69. [PMID: 37291537 DOI: 10.1186/s12904-023-01150-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/22/2023] [Indexed: 06/10/2023] Open
Abstract
Palliative care is increasingly important in the prison setting, but information about the quality and accessibility of this care is extremely limited. Developing and implementing standardised quality indicators will provide transparency, accountability, and a platform for quality improvement at both local and national levels.
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Affiliation(s)
| | - Nicole Heneka
- University of Southern Queensland, Toowoomba, QLD, Australia
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6
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Le Gautier R, Panozzo S, Bryan T, Lethborg C, Philip J. A thematic analysis of hospital medical records of patients with advanced illness experiencing incarceration in the last 3 months of life. Palliat Med 2022; 37:638-645. [PMID: 36476100 DOI: 10.1177/02692163221124033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The constraining prison culture is not, for the most part, conducive to the provision of palliative care for people in prison. AIM This study aimed to explore patterns of palliative and end-of-life care provision for hospitalised prison patients. DESIGN A retrospective qualitative review of hospital medical records to explore the quality of end-of-life care provision for patients experiencing incarceration who died within hospital. Qualitative inductive analysis of record extracts of each patients final 3-months of life was undertaken. SETTING/PARTICIPANTS An Australian metropolitan hospital responsible for providing secondary and tertiary health services for people experiencing incarceration. This study included a systematic sample of male patients experiencing incarceration who died in hospital between 2009 and 2019. RESULTS Medical record extracts of 15 male patients revealed two broad themes: (1) barriers to equitable access to palliative care for incarcerated hospitalised patients; and (2) factors that facilitated quality end-of-life care for patients and families. Barriers included: tensions between balancing risk and humanity; and limited agency over place and death. Conversely, early recognition of deterioration and anticipated dying provided patients and families opportunity to focus on end-of-life goals. CONCLUSIONS Institutional influences of security and control challenged the provision of equitable end-of-life care for people experiencing incarceration. Further research is required to inform, and incorporate, best approaches to identifying patient wishes and advance planning into care within, or despite, the constrains of incarceration. Policy reform and a coordinated, best practice approach to the management of end-of-life care for people experiencing incarceration is needed.
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Affiliation(s)
- Roslyn Le Gautier
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia.,Palliative Nexus, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Stacey Panozzo
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia.,Palliative Nexus, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Tamsin Bryan
- Palliative Care Services, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Carrie Lethborg
- Social Work, St Vincent's Health Australia, Melbourne, VIC, Australia.,College of Health & Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Jennifer Philip
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia.,Palliative Nexus, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
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7
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Schaefer I, DiGiacomo M, Heneka N, Panozzo S, Luckett T, Phillips JL. Palliative care needs and experiences of people in prison: A systematic review and meta-synthesis. Palliat Med 2022; 36:443-461. [PMID: 34965778 DOI: 10.1177/02692163211068278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Globally, the prison population is growing and ageing, as is the need for palliative care. Yet, little is known about how people in prison perceive palliative care provision in this setting. AIMS To identify the: (i) perceptions of palliative care provision and dying in custody by people in prison; and (ii) perceived barriers and facilitators of person-centred palliative care provision in prison. DESIGN A systematic review and meta-synthesis was registered and undertaken in accordance with the reporting guidelines. DATA SOURCES Keywords and MeSH headings encompassing (i) palliative care, end-of-life care, death; and (ii) prison; were used to search Pubmed, Medline, CINAHL, PsycINFO, Web of Science, CINCH and ProQuest Central. Articles published in English, from high income countries, and containing qualitative data exploring perceptions of people in prison of palliative care in custody were included. Findings were reporting using the ENTREQ guidelines. FINDINGS Of the 2193 articles identified, 12 were included. Experiences of people in prison regarding palliative care related to two themes: (1) expectations versus experiences of palliative care; and (2) prison context complicates access to and provision of palliative care. People in prison with palliative care needs want to feel safe, cared for, and acknowledged as they face an expected death. The prison environment can severely restrict access to palliative care, leaving people in prison feeling isolated and powerless. CONCLUSIONS People in prison expect to receive high-quality palliative care, but their experiences often do not match their expectations. Numerous structural and organisational challenges complicate the provision of palliative care in prisons, limiting accessibility of care.
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Affiliation(s)
| | | | - Nicole Heneka
- University of Technology Sydney, Sydney, NSW, Australia
| | | | - Tim Luckett
- University of Technology Sydney, Sydney, NSW, Australia
| | - Jane L Phillips
- Queensland University of Technology, Brisbane, QLD, Australia
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8
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Lattimer TA, Tenzek KE, Ophir Y, Sullivan SS. Exploring Online Twitter Conversations surrounding National Healthcare Decisions Day and Advance Care Planning from a Socio-Cultural Perspective: A Computational Mixed-Methods Analysis (Preprint). JMIR Form Res 2021; 6:e35795. [PMID: 35416783 PMCID: PMC9047726 DOI: 10.2196/35795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/07/2022] [Accepted: 03/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background Within the cultures and societies of the United States, topics related to death and dying continue to be taboo, and as a result, opportunities for presence and engagement during the end of life, which could lead to a good death, are avoided. Several efforts have been made to help people engage in advance care planning (ACP) conversations, including completing advance care directives so that they may express their goals of care if they become too sick to communicate their wishes. A major effort in the United States toward encouraging such challenging discussions is the annual celebration of the National Healthcare Decisions Day. Objective This study aimed to explore ACP from a sociocultural perspective by using Twitter as a communication tool. Methods All publicly available tweets published between August 1, 2020, and July 30, 2021 (N=9713) were collected and analyzed using the computational mixed methods Analysis of Topic Model Network approach. Results The results revealed that conversations driven primarily by laypersons (7107/7410, 95.91% of tweets originated from unverified accounts) surrounded the following three major themes: importance and promotion, surrounding language, and systemic issues. Conclusions On the basis of the results, we argue that there is a need for awareness of the barriers that people may face when engaging in ACP conversations, including systemic barriers, literacy levels, misinformation, policies (including Medicare reimbursements), and trust among health care professionals, in the United States. This is incredibly important for clinicians and scholars worldwide to be aware of as we strive to re-envision ACP, so that people are more comfortable engaging in ACP conversations. In terms of the content of tweets, we argue that there is a chasm between the biomedical and biopsychosocial elements of ACP, including patient narratives. If used properly, Twitter conversations and National Health Care Decision Day hashtags could be harnessed to serve as a connecting point among organizations, physicians, patients, and family members to lay the groundwork for the trajectory toward a good death.
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Affiliation(s)
- Tahleen A Lattimer
- Department of Communication, University at Buffalo, SUNY, East Amherst, NY, United States
| | - Kelly E Tenzek
- Department of Communication, University at Buffalo, SUNY, East Amherst, NY, United States
| | - Yotam Ophir
- Department of Communication, University at Buffalo, SUNY, East Amherst, NY, United States
| | - Suzanne S Sullivan
- School of Nursing, University at Buffalo, SUNY, East Amherst, NY, United States
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9
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Aziz H, Ackah RL, Whitson A, Oppong B, Obeng-Gyasi S, Sims C, Pawlik TM. Cancer Care in the Incarcerated Population: Barriers to Quality Care and Opportunities for Improvement. JAMA Surg 2021; 156:964-973. [PMID: 34406357 DOI: 10.1001/jamasurg.2021.3754] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Importance Cancer is the leading cause of mortality in incarcerated individuals older than 45 years and the fourth leading cause of mortality overall. Health care professionals face increasing challenges to provide high-quality care under the confines of prison regulations and procedures. Observations Adjusted for age, race, sex, and year of diagnosis, the standardized incidence ratio for all cancers is more than 2-fold higher in incarcerated vs general populations. Among deaths occurring in state and federal prison systems, cancer is the overall leading cause of mortality with lung cancer being the leading cause of cancer-related mortality followed by liver, colon, and pancreatic cancers, respectively. Access to high-quality oncological services remains variable; however, cost of care represents about a fifth of overall annual prison expenditures. Given the enormous patient burden, coupled with the rushed discretionary screenings performed by jail and prison nursing staff, early cancer symptoms are often missed altogether or misdiagnosed as a chronic illness or as acute infections. As such, many incarcerated individuals present with more advanced cancer stage. Incarcerated individuals have limited, if any, access to the internet, social media, and other sources of information, which severely limits their ability to research treatment options. Within the prison setting, access to professionals with special skills in assisting with social and spiritual concerns is also generally limited, and less than 4% of prisons have hospice programs. There are no uniform quality-of-care monitoring standards for correctional systems and facilities, nor are there mechanisms for reporting comparable performance data to enforce quality control within correctional health care systems. Conclusions and Relevance There is a growing trend in cancer incidence among incarcerated patients, which is multifactorial including barriers in access to care, increased burden of chronic medical conditions, and decreased screening tests. Efforts are needed to ensure quality health care outcomes for incarcerated patients with cancer.
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Affiliation(s)
- Hassan Aziz
- Department of Surgery, Tufts School of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Ruth L Ackah
- Division of Surgical Oncology, Department of Surgery, Ohio State University Wexner Medical Center, Columbus
| | - Amy Whitson
- Division of Trauma and Critical Care, Department of Surgery, Ohio State University Wexner Medical Center, Columbus
| | - Bridget Oppong
- Division of Surgical Oncology, Department of Surgery, Ohio State University Wexner Medical Center, Columbus
| | - Samilia Obeng-Gyasi
- Division of Surgical Oncology, Department of Surgery, Ohio State University Wexner Medical Center, Columbus
| | - Carrie Sims
- Division of Trauma and Critical Care, Department of Surgery, Ohio State University Wexner Medical Center, Columbus
| | - Timothy M Pawlik
- Division of Surgical Oncology, Department of Surgery, Ohio State University Wexner Medical Center, Columbus.,Deputy Editor, JAMA Surgery
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McParland C, Johnston B. Caring, sharing, preparing and declaring: how do hospices support prisons to provide palliative and end of life care? A qualitative descriptive study using telephone interviews. Palliat Med 2021; 35:563-573. [PMID: 33302784 PMCID: PMC7975864 DOI: 10.1177/0269216320979194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Older adults in prison have complex healthcare needs, and many will need palliative care before their sentence ends. Compared with prison-based hospices, little is known about the role played by community-based hospices in providing palliative care to people in prison. AIM To describe the roles Scottish hospices have adopted to support prisons to provide palliative care, and to discuss the international relevance of these findings in addressing the knowledge gap around community hospices supporting people in prison. DESIGN A qualitative descriptive study using semi-structured telephone interviews. SETTING/PARTICIPANTS Representatives from all Scottish adult hospices were invited to take part in a short telephone interview and all (N = 17) participated. RESULTS Four roles were identified: caring, sharing, preparing and declaring. Most hospices employed different combinations of roles. Five (30%) hospices were engaged in caring (providing direct care at the prison or the hospice). Eleven (65%) hospices were engaged in sharing (supporting the prison by sharing knowledge and expertise). Eleven (65%) hospices were engaged in preparing (making preparations to support prisons). All seventeen hospices were described as declaring (expressing a willingness to engage with prisons to provide care). CONCLUSIONS There are differences and similarities in the way countries provide palliative care to people in prison: many are similar to Scotland in that they do not operate prison-based hospices. Variations exist in the level of support hospices provide. Ensuring that all people in prison have equitable access to palliative care will require close collaboration between prisons and hospices on a national level.
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Affiliation(s)
- Chris McParland
- School of Medicine, Dentistry and
Nursing, University of Glasgow, Glasgow, UK
- NHS Greater Glasgow and Clyde, Glasgow,
UK
| | - Bridget Johnston
- School of Medicine, Dentistry and
Nursing, University of Glasgow, Glasgow, UK
- NHS Greater Glasgow and Clyde, Glasgow,
UK
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