"We Take Care of Patients, but We Don't Advocate for Them": Advance Care Planning in Prison or Jail
- 9 October 2018
- journal article
- research article
- Published by Wiley in Journal of the American Geriatrics Society
- Vol. 66 (12), 2382-2388
- https://doi.org/10.1111/jgs.15624
Abstract
Objectives To investigate correctional healthcare providers’ knowledge of and experience with advance care planning (ACP), their perspectives on barriers to ACP in correctional settings, and how to overcome those barriers. Design Qualitative. Setting Four prisons in 2 states and 1 large city jail in a third state. Participants Correctional healthcare providers (e.g., physicians, nurses, social workers; N=24). Results Participants demonstrated low baseline ACP knowledge; 85% reported familiarity with ACP, but only 42% provided accurate definitions. Fundamental misconceptions included the belief that providers provided ACP without soliciting inmate 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 or jail, inmate mistrust of the correctional healthcare system, inmates’ isolation from family and 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 inmates, revising policies that limit ACP, and systematically integrating ACP into healthcare practice. Conclusion Despite an increasing number of older and seriously ill individuals in prisons and jails, many correctional healthcare providers lack knowledge about ACP. In addition to ACP barriers found in the community, there are unique barriers to ACP in prisons and jails. Future research and policy innovation are needed to develop clinical training programs and identify ACP implementation strategies for use in correctional settings.Keywords
Funding Information
- Tideswell at UCSF
- Cambia Health Foundation
- National Palliative Care Research Center
This publication has 25 references indexed in Scilit:
- Addressing the Aging Crisis in U.S. Criminal Justice Health CareJournal of the American Geriatrics Society, 2012
- Advance care planning in COPDRespirology, 2011
- Prevalence of chronic medical conditions among jail and prison inmates in the USA compared with the general populationJournal of Epidemiology and Community Health, 2009
- Thirty Years After Estelle v. Gamble: A Legal RetrospectiveJournal of Correctional Health Care, 2007
- Comparing Incarcerated and Community-Dwelling Older Men's HealthWestern Journal of Nursing Research, 2007
- Improving End-of-life Care of PrisonersJournal of Correctional Health Care, 2005
- Why Don't Patients and Physicians Talk About End-of-Life Care?: Barriers to Communication for Patients With Acquired Immunodeficiency Syndrome and Their Primary Care CliniciansArchives of Internal Medicine, 2000
- The Discussion About Advance DirectivesArchives of Internal Medicine, 1995
- The discussion about advance directives. Patient and physician opinions regarding when and how it should be conducted. End of Life Study GroupArchives of Internal Medicine, 1995
- Advance Directives for Medical Care — A Case for Greater UseNew England Journal of Medicine, 1991