Abstract
Background: Prisons are complex, restrictive organizations that care for highly vulnerable individuals. Geriatric inmates (age ≥ 50) are the fastest-growing age-cohort in prisons. They are living with and dying from chronic illnesses Prisons are harsh contexts and inmates' particularly fear dying alone there. We have good science on what to do in terms of end-of-life (EOL) care—we now need to better infuse this knowledge into complex organizations such as prisons so that wherever people die, they die comfortably and with dignity. Purpose: To compare and contrast the current status of EOL care in contextually diverse prison communities; evaluate the infusion of modified approaches to EOL care using an intervention toolkit to meet the prioritized needs identified by stakeholders in diverse correctional facilities; and identify resource utilization data that are most appropriate for determining cost effectiveness of modified approaches to EOL care. Methodology: Participatory Action Research will involve both qualitative and quantitative strategies. Data will be managed using Atlasti and SAS, respectively. Analytic techniques will include content, thematic, qualitative outcome, and cost effectiveness analyses. Together with Nursing and Health Economics researchers, a large multi-disciplinary team of co-researchers from state prisons will collaborate, interpret data, prioritize issues/needs, tailor EOL strategies that fit with organizational constraints, and interpret outcomes. Findings: Our findings will include a description of values, beliefs, and perceptions of system wide needs across six state prisons A generalist toolkit of EOL resources will be created to enable prisons to meet EOL care needs. Next, a master plan of strategic implementation will be developed and applied. Finally, the cost-effectiveness of the medical and behavioral interventions will be determined. Summary Concluding Statement: Improving EOL care for inmates who are suffering from advanced chronic illnesses will lay the crucial groundwork needed for future research aimed at infusing generalist EOL strategies into other complex organizations.
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