Facilitators and Barriers in Palliative and End-of-Life Care in Prisons.

Abstract

With an aging prison population facing various chronic diseases, the importance of palliative and end-of-life care (EOLC) in correctional facilities is heightened. This systematic review aimed to identify facilitators and barriers to palliative and EOLC in prisons. PubMed, Web of Science, Scopus, and Cochrane databases were searched for primary qualitative studies (January 2014 to December 2022) in English. Eligible studies focused on people in prison, health care professionals, administrators, and governors regarding palliative or EOLC provision within prison settings. Five studies were included, from Australia, France, the United Kingdom, and the United States, whose overall quality was moderate to high. Key facilitators included access to family, support from prison staff, specialized care availability, and cultural/spiritual support. Barriers encompassed discomfort, patient-clinician relationship constraints, time limitations, protocol uncertainty, restricted patient agency, negative attitudes, inequality, conflicting priorities, and lack of grief support. Addressing these barriers and leveraging facilitators will be crucial in ensuring equitable access to compassionate EOLC for individuals experiencing incarceration. Policymakers, health care providers, and correctional authorities must prioritize the enhancement of palliative care services within prisons, supported by further research and targeted interventions to address disparities and optimize care provision.