End-of-Life Care in Correctional Settings: A Scoping Literature Review

Background and Purpose

The complexities of care, privatization and lack of funding are only a few of the challenges in providing end-of-life care in a correctional setting. With an aging incarcerated population comes an increased need to access health care professionals and services; however, research indicates an alarming number of barriers associated with access to and quality of care. The objective of this scoping literature review is to summarize the quality and primary outcomes measured within the end-of-life care in correctional settings literature. Social workers have played critical roles in mental health and health care provision in correctional facilities. With a deep understanding of the hospice philosophy, social workers champion for increased visiting hours for families, encourage correctional staff members to communicate with families about an inmate’s health, and advocate for inmate requests for special foods and accommodations to increase comfort. There is vast potential to close the health gap, reflecting one of the Grand Challenges for Social Work. This presentation will synthesize the current state of the literature, gaps in care, and potential areas for social work clinical interventions and research.

Methods

A scoping review was completed using PRISMA guidelines. CAB Abstracts, CINAHL, Cochrane Library, ERIC, Google Scholar, MEDLINE, PsycINFO, PubMed, Social Services Abstracts, and Social Work Abstracts were searched from inception to December 2019. Inclusion criteria included: 1) care was provided through a hospice-based program in a correctional setting, 2) qualitative outcomes were reported, and 3) reported original data. Thematic component analysis was completed to categorize related interventions and barriers.

Results

Forty-seven studies formed the final data set. Data analysis revealed five main themes: goals of end-of-life care, challenges of “dying well”, peer-caregiver support, issues related to correctional staff, and improving access to end-of-life care. Primary outcomes were benefits of hospice-based programs, barriers to pain management, and the imperative role of social workers in correctional settings. The majority of studies were of moderate quality and primarily focused on prisons in the US. Gaps in research emphasizes further research on aging and dying inmates’ needs, as well as longitudinal studies of inmate end-of-life care and international palliative care interventions.

Conclusions and Implications

The role of social work in inmate end-of-life care is fundamental. In addition to ethical values, hospice social workers integrate core values to assist in their ongoing efforts to address the challenges of providing hospice care within a prison setting. Hospice social workers can play an integral role in influencing prison and medical staff attitudes toward dying inmates by providing an understanding of how to effectively support this vulnerable population; to treat terminally ill inmates as patients approaching the end-of-life not as individuals for whom suffering and dying are yet another appropriate phase of punishment. To promote social justice for this marginalized population, interventions need to be consistently evaluated with outcomes that improve care for inmates at the end-of-life. Social workers can participate in research which focuses on effective guidelines for correctional facilities to provide compassionate end-of-life care for inmates.