Caring for Terminally-Ill Incarcerated Patients: What to Say, Ask, and Do Across Different Settings (SA527)

Abstract

•Describe health care disparities and challenges regarding access to palliative care and hospice for incarcerated individuals.•Identify and examine unique barriers to providing optimal symptom management to incarcerated people with serious illness.•Explain the eligibility criteria of compassionate release and the processes involved. The United States criminal justice system holds approximately 2.3 million people in correctional facilities—state and federal prisons, jails, and juvenile facilities—which disproportionately impacts people of color and low income. Incarcerated individuals 55 years or older account for four times the healthcare cost compared to their younger counterparts. They often experience accelerated aging because of substance use disorders, insufficient primary care screening, and stress associated with incarceration. Though some correctional facilities have robust medical facilities, many seriously-ill incarcerated patients end up being hospitalized and may interact with palliative care (PC) consultants for symptom management or assistance with complex decision-making. PC teams may desire to provide equitable and quality treatment regardless of their patient's background, yet there is little training that exists on how to work within and through the confines of the correctional system. Due to system barriers, patient's autonomy may be easily compromised. Most state prison systems have a version of “compassionate release.” However, many incarcerated patients are denied compassionate release for not meeting medical requirements. Well-equipped interdisciplinary PC teams can be essential in these settings—with physicians providing accurate prognostication and documentation of hospice eligibility, and social workers and chaplains guiding healthcare staff, incarcerated patients, and their families through the process of compassionate release and preserving dignity for terminally-ill patients. Through didactics, discussion, and case studies, this session will highlight key differences in incarcerated patients' rights and how that impacts their healthcare, particularly regarding symptom management, communication, and medical-decision making. This will include the identification of individuals that may be eligible for compassionate release, and what is involved in that process. By gaining a deeper understanding of the correctional healthcare system, interdisciplinary PC teams will be empowered to better advocate and care for their incarcerated patients.