Miss Isabelle Schaefer1, Dr Stacey Panozzo1,2, Associate Professor Michelle DiGiacomo1, Associate Professor Nicole Heneka1,3, Professor Emerita Jane L Phillips1,4
1University of Technology Sydney, Ultimo, Sydney, Australia, 2St Vincent's Health Australia, Fitzroy, Melbourne, Australia, 3University of Southern Queensland, Springfield, Central QLD, Australia, 4Queensland University of Technology, Kelvin Grove, Brisbane, Australia
Biography:
Isabelle has a background in medical science and is completing her PhD as part of the National Palliative Care in Prisons Project at the University of Technology Sydney. She is lead author of another systematic review and meta-synthesis about the perceptions and experiences of people in prison with palliative care needs.
Abstract:
Background: Demand for palliative care in prisons is growing globally as the prison population increases and ages. Prison and community-based clinicians and correctional officers facilitate palliative care within a restrictive environment and face considerable challenges.
Aim: To explore perceptions and experiences of stakeholders supporting people in prison with palliative care needs in prison, community hospice and hospital.
Methods: A systematic review and meta-synthesis was conducted. PubMed, Medline, ProQuest, CINAHL, Web of Science and CINCH were searched using keywords related to prison and palliative care. English peer-reviewed articles from high-income countries that included qualitative data about stakeholders’ experiences were included.
Results: After screening 2664 articles, 13 were included. Two analytical themes emerged: i) a prison lens on a palliative approach and ii) navigating complexity in prison palliative care.
Clinical practice was heavily restricted by security constraints within this restrictive environment, which negatively impacted care and patient choice. This caused moral distress for clinicians where restrictions deviated from professional values. Officers felt unprepared to manage their unexpected role in facilitating palliative care and lacked guidance about how to accommodate palliative care needs within their mandate to maintain security.
Discussion: The prison environment created a lens through which palliative care was viewed, shaping perceptions of what care could be facilitated within the custodial setting as a subordinate priority to security. Conflicting priorities for various stakeholders caused tension, and unclear policy left stakeholders unsure how to operate. Though officers could make discretionary decisions to bypass protocol to meet patients’ needs, this depended on how stakeholders integrated and prioritised the ‘patient’ and ‘person in prison’ identities of those needing palliative care.
Conclusion: Facilitating palliative care in prison is ethically complex and profoundly impacts clinicians and officers. Additional communication, collaboration and organisational support are needed to deliver quality palliative care in prisons.