Abstract
BackgroundLimited information is available describing advance care planning (ACP) within correctional facilities, despite its increasing relevance due to the ageing population in prisons and the high rates of complex medical comorbidities. In Western countries, self-determination with respect to making future medical decisions is a human right that prisoners do not lose when they are remanded into custody. ACP enables individuals to plan for their health and personal care so their values, beliefs and preferences are made known to inform future decision-making, for a time when they can no longer communicate their decisions. This paper examines the limited academic literature relating to ACP within prisons to identify barriers and facilitators that influence the uptake of ACP and advance care directive (ACD) documentation. Common themes related to ACP in a correctional setting were extracted and synthesised to produce a high-level analysis of barriers and facilitators influencing ACP uptake for prisoners within a correctional setting.ResultsSix articles met the selection criteria and reported on the experience of ACP and ACDs in prisons; five from the United States of America and one from Switzerland. Three dominant themes were identified, with related subthemes: system-level factors, attitudes and perceptions, and ACP knowledge and comprehension. Barriers to ACP and ACD implementation were more prominent in articles than facilitators.ConclusionsLimited academic literature regarding the implementation and experience of ACP in prisons is available. The dominance of barriers identified in studies highlights key challenges for improving ACP uptake in correctional settings. Further research is required to understand the barriers, enablers, and attitudes to ACP in prisons.
Highlights
Limited information is available describing advance care planning (ACP) within correctional facilities, despite its increasing relevance due to the ageing population in prisons and the high rates of complex medical comorbidities
Advance care planning (ACP), palliative care, and endof-life care is increasingly relevant within correctional facilities due to the ageing population in prisons and the high rates of complex medical comorbidities in older prison populations (Australian Institute of Health and Welfare, 2019; Enggist, Møller, Galea, & Udesen, 2014)
Papers were included if they were qualitative or quantitative empirical research studies published in English addressing ACP and advance care directive (ACD) practices or interventions in prisons, investigated barriers associated with implementing ACP programs in prisons, or were studies investigating prisoners and health care providers’ experiences with ACP or ACDs
Summary
Limited information is available describing advance care planning (ACP) within correctional facilities, despite its increasing relevance due to the ageing population in prisons and the high rates of complex medical comorbidities. ACP enables individuals to plan for their health and personal care so their values, beliefs and preferences are made known to inform future decision-making, for a time when they can no longer communicate their decisions. The process of ACP is described as planning for one’s future health and care where the person’s values, beliefs and preferences are made known to inform future decision-making if the person can no longer communicate their decisions (Working Group of the Clinical (2020) 8:22. Noted benefits of engaging in ACP include: reduced burden on acute hospital services, greater use of hospice at end-of-life, medical care that focuses on patient comfort rather than prolonging life at any cost, better alignment of treatment received with a patient wishes, greater patient satisfaction with care, and reduced anxiety and stress for surviving relatives
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