Bringing Advanced Care Planning to Prisons

Investigator: Brie Williams, MD

Location(s): United States


The number of persons dying in prison is growing, driven by a precipitous rise in the number of older and seriously ill prisoners. Over 75 prisons now have hospice units, but with over 2.000 U.S. prisons, these hospices serve just a fraction of dying individuals. Palliative care - with its focus on establishing goals of care and attention to quality of life throughout serious illness - is frequently absent from prison healthcare outside of hospice. A cornerstone of palliative care is Advanced Care Planning (ACP). ACP is used to identify patients’ goals of care, clarify their definition of quality of life, and ensure communication of their wishes to clinicians. In this Pilot Project we will develop a model ACP Prison Program comprised of clinician training and resources (written procedures and modified evidence-based ACP tools) designed specifically for use in the unique prison healthcare setting. Our long-term goal is to test and refine the model program in prisons nationwide so that it can be disseminated to ensure that all prisoners with serious illness or of advanced age have their healthcare wishes elicited, understood, and followed.