Advance Care Planning: Perspectives of People Living in Prison.
Erin Kitt-Lewis, Nanda Zheng, Susan J Loeb
PMID 38683576WHAT IT FOUND
People living in prison described advance care planning as a routine health conversation, not a sign of imminent death.
They wanted trusted staff to explain chronic conditions clearly and asked for written wishes to be honored, including post-death arrangements.
Key findings
01Participants preferred the term 'advance care planning' because 'advance directives' and 'death' were viewed as too harsh and acted as barriers to engagement.
02Individuals wanted ACP integrated into routine health visits and annual reviews to normalize the conversation and avoid implying a terminal diagnosis.
03Mistrust of prison staff was a major barrier, with participants reporting that medical records were hard to access and that end-of-life wishes were often ignored or not explained.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Findings cannot be generalized beyond the two specific prisons in one state. Data relied on handwritten notes because audio recording was prohibited, risking loss of precision. One participant did not contribute to the discussion, so not all voices were represented. The study did not include perspectives from prison staff, which limits understanding of systemic barriers from the provider side.
Declared interests
The author has no conflicts of interest to disclose.
The easy way to misread this
Do not assume that introducing ACP conversations will be welcomed by all incarcerated patients. Participants reported that acknowledging illness or engaging in end-of-life planning could lead to undesirable outcomes like infirmary confinement, loss of social connection, or job loss, so these discussions require careful trust-building and privacy assurances.