Palliative and end-of-life care in prisons: a content analysis of the literature

• Published in: International Journal of Prisoner Health 2014-01, Vol.10 (3), p.172-197
• Main Authors: Maschi, Tina, Marmo, Suzanne, Han, Junghee
• Format: Article
• Language: English
• Subjects: Advance Care Planning; Advocacy; Barriers; Best practice; Communities; Compassionate care; Content analysis; Crime; Criminal justice system; Death & dying; Drugs; Emotional behavior; End of life; End of life decisions; Ethical dilemmas; Health care; Health care expenditures; Hospice care; Hospices; Hospices - organization & administration; Housing; Human Rights; Humans; Judicial system; Neoplasms - epidemiology; Neoplasms - therapy; Older people; Pain; Palliation; Palliative care; Palliative Care - organization & administration; Parole & probation; Parole officers; Partnerships; Policy reform; Prisoners; Prisons; Prisons - organization & administration; Public awareness; Punishment; Qualitative analysis; Qualitative research; Reviews; Safety; Terminal Care - organization & administration; Torture; Trust
• ISSN: 1744-9200; 2977-0254; 1744-9219; 2977-0262
• DOI: 10.1108/IJPH-05-2013-0024

Purpose The growing numbers of terminally ill and dying in prison has high economic and moral costs as global correctional systems and the society at large. However, to date little known about the extent to which palliative and end-of-life care is infused within global prison health care systems. The purpose of this review is to fill a gap in the literature by reviewing and critically appraising the methods and major findings of the international peer-reviewed literature on palliative and end-of-life care in prison, identify the common elements of promising palliative and end-of-life services in prison, and what factors facilitated or create barrier to implementation. Design/methodology/approach A content analysis was conducted of the existing peer-reviewed literature on palliative and end-of-life care in prison. English-language articles were located through a comprehensive search of peer-reviewed journals, such as Academic Search Premier Literature databases using differing combinations of key word search terms, “prison”, “palliative care”, and ‘end-of-life care’. A total of 49 studies published between 1991-2013 met criteria for sample inclusion. Deductive and inductive analysis techniques were used to generate frequency counts and common themes related to the methods and major findings. Findings The majority (n=38) of studies were published between 2000-2013 in the United States (n=40) and the United Kingdom (n=7). Most were about U.S. prison hospice programs (n=16) or barriers to providing palliative and end of life care in prisons (n=10). The results of the inductive analysis identified common elements of promising practices, which included the use of peer volunteers, multi-disciplinary teams, staff training, and partnerships with community hospices. Obstacles identified for infusing palliative and end-of-life care in prison included ethical dilemmas based on custody versus care, mistrust between staff and prisoners, safety concerns, concern over prisoners’ potential misuse of pain medication, and institutional, staff, and public apathy towards terminally ill prisoners and their human rights to health in the form of compassionate and palliative care, including the use of compassionate release laws. Research limitations/implications Implications for future research that foster human rights and public awareness of the economic and moral costs of housing the sick and dying in prisons. More research is needed to document human rights violations as well a