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"We Take Care of Patients, but We Don't Advocate for Them": Advance Care Planning in Prison or Jail.
J Am Geriatr Soc. 2018 12; 66(12):2382-2388.JA

Abstract

OBJECTIVES

To investigate correctional healthcare providers' knowledge of and experience with advance care planning (ACP), their perspectives on barriers to ACP in correctional settings, and how to overcome those barriers.

DESIGN

Qualitative.

SETTING

Four prisons in 2 states and 1 large city jail in a third state.

PARTICIPANTS

Correctional healthcare providers (e.g., physicians, nurses, social workers; N=24).

RESULTS

Participants demonstrated low baseline ACP knowledge; 85% reported familiarity with ACP, but only 42% provided accurate definitions. Fundamental misconceptions included the belief that providers provided ACP without soliciting inmate input. Multiple ACP barriers were identified, many of which are unique to prison and jail facilities, including provider uncertainty about the legal validity of ACP documents in prison or jail, inmate mistrust of the correctional healthcare system, inmates' isolation from family and friends, and institutional policies that restrict use of ACP. Clinicians' suggestions for overcoming those barriers included ACP training for clinicians, creating psychosocial support opportunities for inmates, revising policies that limit ACP, and systematically integrating ACP into healthcare practice.

CONCLUSION

Despite an increasing number of older and seriously ill individuals in prisons and jails, many correctional healthcare providers lack knowledge about ACP. In addition to ACP barriers found in the community, there are unique barriers to ACP in prisons and jails. Future research and policy innovation are needed to develop clinical training programs and identify ACP implementation strategies for use in correctional settings. J Am Geriatr Soc 66:2382-2388, 2018.

Authors+Show Affiliations

Division of Geriatrics, University of California San Francisco, San Francisco, California.Division of Geriatrics, University of California San Francisco, San Francisco, California.Division of Geriatrics, University of California San Francisco, San Francisco, California.New York Medical College, Valhalla, New York.Division of Geriatrics, University of California San Francisco, San Francisco, California.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30300941

Citation

Ekaireb, Rachel, et al. ""We Take Care of Patients, but We Don't Advocate for Them": Advance Care Planning in Prison or Jail." Journal of the American Geriatrics Society, vol. 66, no. 12, 2018, pp. 2382-2388.
Ekaireb R, Ahalt C, Sudore R, et al. "We Take Care of Patients, but We Don't Advocate for Them": Advance Care Planning in Prison or Jail. J Am Geriatr Soc. 2018;66(12):2382-2388.
Ekaireb, R., Ahalt, C., Sudore, R., Metzger, L., & Williams, B. (2018). "We Take Care of Patients, but We Don't Advocate for Them": Advance Care Planning in Prison or Jail. Journal of the American Geriatrics Society, 66(12), 2382-2388. https://doi.org/10.1111/jgs.15624
Ekaireb R, et al. "We Take Care of Patients, but We Don't Advocate for Them": Advance Care Planning in Prison or Jail. J Am Geriatr Soc. 2018;66(12):2382-2388. PubMed PMID: 30300941.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - "We Take Care of Patients, but We Don't Advocate for Them": Advance Care Planning in Prison or Jail. AU - Ekaireb,Rachel, AU - Ahalt,Cyrus, AU - Sudore,Rebecca, AU - Metzger,Lia, AU - Williams,Brie, Y1 - 2018/10/09/ PY - 2018/06/08/received PY - 2018/08/03/revised PY - 2018/08/23/accepted PY - 2018/10/10/pubmed PY - 2019/9/19/medline PY - 2018/10/10/entrez KW - advance care planning KW - geriatrics KW - prisoners KW - vulnerable populations SP - 2382 EP - 2388 JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc VL - 66 IS - 12 N2 - OBJECTIVES: To investigate correctional healthcare providers' knowledge of and experience with advance care planning (ACP), their perspectives on barriers to ACP in correctional settings, and how to overcome those barriers. DESIGN: Qualitative. SETTING: Four prisons in 2 states and 1 large city jail in a third state. PARTICIPANTS: Correctional healthcare providers (e.g., physicians, nurses, social workers; N=24). RESULTS: Participants demonstrated low baseline ACP knowledge; 85% reported familiarity with ACP, but only 42% provided accurate definitions. Fundamental misconceptions included the belief that providers provided ACP without soliciting inmate input. Multiple ACP barriers were identified, many of which are unique to prison and jail facilities, including provider uncertainty about the legal validity of ACP documents in prison or jail, inmate mistrust of the correctional healthcare system, inmates' isolation from family and friends, and institutional policies that restrict use of ACP. Clinicians' suggestions for overcoming those barriers included ACP training for clinicians, creating psychosocial support opportunities for inmates, revising policies that limit ACP, and systematically integrating ACP into healthcare practice. CONCLUSION: Despite an increasing number of older and seriously ill individuals in prisons and jails, many correctional healthcare providers lack knowledge about ACP. In addition to ACP barriers found in the community, there are unique barriers to ACP in prisons and jails. Future research and policy innovation are needed to develop clinical training programs and identify ACP implementation strategies for use in correctional settings. J Am Geriatr Soc 66:2382-2388, 2018. SN - 1532-5415 UR - https://www.unboundmedicine.com/medline/citation/30300941/"We_Take_Care_of_Patients_but_We_Don't_Advocate_for_Them":_Advance_Care_Planning_in_Prison_or_Jail_ L2 - https://doi.org/10.1111/jgs.15624 DB - PRIME DP - Unbound Medicine ER -