Administrators' perspectives on changing practice in end-of-life care in a state prison system

Area of Science:

• Corrections and Criminal Justice
• Geriatric Care
• Public Health Policy

Background:

• Aging prison populations necessitate enhanced end-of-life (EOL) care services.
• Correctional settings face significant barriers to implementing EOL care, including financial, attitudinal, and organizational challenges.

Purpose of the Study:

• To explore administrators' perspectives on EOL care within a state prison system.
• To identify challenges hindering the implementation of improved EOL care for inmates with advanced illnesses.

Main Methods:

• Qualitative study utilizing semi-structured interviews.
• Conducted interviews with 12 central office administrators from a state department of corrections.

Main Results:

• Key factors influencing EOL care services include prison culture, security versus treatment focus, and budget considerations.
• Conflicting service targets and public sentiment also impact the delivery of EOL care.
• Case-by-case decision-making is a prevalent approach.

Conclusions:

• Understanding administrative perspectives is crucial for developing effective strategies to change practice in correctional EOL care.
• Organizational structures, attitudes, and beliefs significantly influence care delivery.
• Contextual evaluation is vital for implementing new practices in complex, hierarchical systems caring for vulnerable populations.