"We Take Care of Patients, but We Don't Advocate for Them": Advance Care Planning in Prison or Jail
"We Take Care of Patients, but We Don't Advocate for Them": Advance Care Planning in Prison or Jail
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DOI：
10.1111/jgs.15624
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发表时间：
2018-12-01
影响因子：
6.3
通讯作者：
Williams, Brie
中科院分区：
文献类型：
--
作者：
Ekaireb, Rachel;Ahalt, Cyrus;Williams, Brie
目的调查惩教保健提供者的知识和经验与预先护理计划（ACP），他们的观点的障碍，ACP在惩教设置，以及如何克服这些障碍。设计定性。设置四所监狱在2个州和1个大城市监狱在第三个国家。医生，护士，社会工作者; N=24）。结果参与者表现出较低的基线ACP知识; 85%的报告与ACP熟悉，但只有42%提供准确的定义。基本的误解包括认为提供者提供ACP而不征求囚犯的意见。确定了多个ACP障碍，其中许多是监狱和监狱设施所特有的，包括提供者对监狱或监狱中ACP文件的法律的有效性的不确定性，囚犯对惩教保健系统的不信任，囚犯与家人和朋友的隔离，以及限制使用ACP的机构政策。临床医生的建议，为克服这些障碍，包括ACP培训的临床医生，创造社会心理支持的机会，囚犯，修改政策，限制ACP，并系统地将ACP纳入healthcare practice.ConclusionDespite越来越多的老年人和重病患者在监狱和监狱，许多惩教保健提供者缺乏知识ACP。除了在社区中发现的ACP障碍外，监狱和监狱中也存在ACP的独特障碍。需要未来的研究和政策创新来开发临床培训计划并确定用于惩教环境的ACP实施策略。J Am Geriatr Soc 66：2382-2388，2018.
ObjectivesTo investigate correctional healthcare providers' knowledge of and experience with advance care planning (ACP), their perspectives on barriers to ACP in correctional settings, and how to overcome those barriers.DesignQualitative.SettingFour prisons in 2 states and 1 large city jail in a third state.ParticipantsCorrectional healthcare providers (e.g., physicians, nurses, social workers; N=24).ResultsParticipants demonstrated low baseline ACP knowledge; 85% reported familiarity with ACP, but only 42% provided accurate definitions. Fundamental misconceptions included the belief that providers provided ACP without soliciting inmate input. Multiple ACP barriers were identified, many of which are unique to prison and jail facilities, including provider uncertainty about the legal validity of ACP documents in prison or jail, inmate mistrust of the correctional healthcare system, inmates' isolation from family and friends, and institutional policies that restrict use of ACP. Clinicians' suggestions for overcoming those barriers included ACP training for clinicians, creating psychosocial support opportunities for inmates, revising policies that limit ACP, and systematically integrating ACP into healthcare practice.ConclusionDespite an increasing number of older and seriously ill individuals in prisons and jails, many correctional healthcare providers lack knowledge about ACP. In addition to ACP barriers found in the community, there are unique barriers to ACP in prisons and jails. Future research and policy innovation are needed to develop clinical training programs and identify ACP implementation strategies for use in correctional settings. J Am Geriatr Soc 66:2382-2388, 2018.