Barriers and Facilitators in Providing Palliative and End-of-Life Care in Prison Settings: A Qualitative Study of Professional Stakeholders’ Views and Experiences in Six Western Countries

Abstract

Increasing numbers of people require palliative end-of-life care (PEOLC) within prison settings, mainly because of aging populations and increasingly long sentences. There is limited research in this area, but evidence suggests that prisons possess limited resources to provide adequate care for aging and frail people at the end of life. This study aimed to explore how PEOLC is provided in prisons in different countries and identify factors that facilitate or impede its provision. A cross-sectional qualitative study using semistructured interviews was utilized to interview prison and health care staff involved in the organization and/or delivery of PEOLC to incarcerated adults in six countries. Sampling was purposive and adopted a snowball technique. Data were analyzed using framework analysis. This study provides evidence that numerous barriers exist that can impede the organization and delivery of PEOLC to people in prison, including barriers at the individual, staff, organization, and regulatory levels. Facilitators coexisted alongside the barriers. Similar barriers and facilitators were identified in each country. Despite some good practices, multiple challenges remain in providing the same quality of PEOLC that is available outside prison, and thus, those dying in prison continue to be disadvantaged.