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Improving End-of-life Care of Prisoners

Health care providers at the University of Connecticut and Connecticut Department of Corrections were surveyed to assess knowledge of, prevalence of, and procedures for completion of advance directives, as well as perceptions and beliefs concerning related issues. Results: Fewer than 1% of inmates have advance directive discussions. Fewer still complete an advance directive, and those that do nearly always have a do-not-resuscitate order. Providers agree that advance directive discussions usually occur at the least optimal time in an inmate's illness. Opinions differ as to barriers to effective discussions. Whether mental illness and competency affect end-of-life care is not clear to most providers. Opinions also differ with regard to fundamental issues of prisoners' access to and rights to care. Conclusions: Removing systemic barriers may be a starting point toward establishing more consistency in advance directive discussions and delivery of end-of-life care in this population.