Ms Isabelle Schaefer1, Associate Professor Michelle DiGiacomo1, Associate Professor Nicole Heneka3, Dr Stacey Panozzo4, Professor Jane L Phillips1,2
1University Of Technology Sydney, Ultimo, Australia, 2Queensland University of Technology, Brisbane, Australia, 3University of Southern Queensland, Springfield, Australia, 4University of Melbourne, Melbourne, Australia
Biography:
Isabelle is a PhD student at the University of Technology Sydney, focusing on the barriers and facilitators of person-centred palliative care for people in NSW prisons.
Abstract:
Background:
Natural deaths are rising in Australian prisons, increasing demand for palliative care. While gaps between prison and community palliative care have been reported, little is known about whether these exist in Australia. Identifying factors shaping person-centred palliative care (PCPC) will help develop targeted strategies for quality end-of-life care in prison.
Aim:
To identify factors affecting PCPC for people in prison as perceived by prison and hospital clinicians, using Mead and Bower’s model of person-centred care.
Methods:
Semi-structured interviews with clinicians from a maximum-security NSW prison and a tertiary hospital providing acute off-site medical care. Key factors were identified through template thematic analysis, adapting Mead and Bower’s model of person-centred care to the prison context.
Results:
Participants (N=24) were predominantly female (n=16) prison clinicians (n=18), in nursing (n=8). Factors affecting PCPC comprised patient, provider, point-of-care, (reported here) and non-medical environment, system and shapers.
Participants perceived that patients’ personalities, health conditions, and attitudes influenced PCPC by shaping their behaviour, choices, and care expectations. Anti-social behaviours and noncompliance limited PCPC, requiring clinicians to negotiate care with patients and consider the prison environment’s effect on decision-making. Participants noted that providers’ attitudes and values affected PCPC, emphasising that all patients should receive dignified end-of-life care regardless of their offences. Participants’ suggested providers’ willingness to form therapeutic alliances and work creatively within security rules also influenced PCPC. At the point-of-care, participants perceived that limited patient access, specialist support, and palliative care beds restricted PCPC delivery, with strict opioid controls and limited end-of-life care choices. Positive relationships and collaboration with correctional officers supported PCPC.
Conclusions:
Incarceration strongly shaped the access to PCPC in prison, demonstrating considerable gaps in care. Partnering with stakeholders to develop targeted strategies addressing the impacts of prison on PCPC is essential to bridge gaps in quality and equality in PCPC.