Table 3

Qualitative and mixed methods studies

Citation and country	Participants	Design	Aim	Key findings	Key methodological strengths and limitations; quality score
Chassagne et al 2 (2017) France	Prisoners requiring palliative and end of life care (n=14) and those around them	Qualitative (unspecified)/ interviews	To highlight the realities regarding inmates at the end of life in France	Themes: The limits of palliative and supportive care in prison The boundary between inmate and patient in UHSI (a high-security ward for inmates based in a local hospital). The environment and equipment limit the ability to deliver palliative care in prisons. Conflicting priorities between care and custody in the UHSI also impact on care delivery.	Strengths: Evident and appropriate design, study context clear, sampling appropriate and well described, well supported conclusions Limitations: Limited information on data collection and analysis, no verification procedures described, limited information on reflexivity Quality score: 63%
Cloyes et al 31 (2014) USA	Louisiana inmate hospice volunteers who responded to a survey (n=75)	Ethnographic grounded theory/ surveys	To explore the beliefs and attitudes of inmate hospice volunteers, including motivations and the meaning of hospice to them	Themes: Transforming personal identity Expressing true self Personal redemption Doing God’s work Living the golden rule Witnessing and legacy vs passing without notice Stepping up Paying it forward by giving back Collective identity through common humanity. Inmate hospice volunteers view hospice as a transformative experience, which changes them for the better.	Strengths: Question sufficiently described, study context clear, sampling appropriate and well described, data collection appropriate and well described, data analysis appropriate and well described, verification procedures present, well-supported conclusions Limitations: Partial connection to theoretical framework, limited information on reflexivity Quality score: 85%
Cloyes et al 29 (2016) USA	Louisiana State Penitentiary prisoners, inmate hospice volunteers, healthcare staff and corrections officers (n=43)	Ethnographic case study/ interviews and observations	To describe factors essential to sustaining the prison hospice, from prisoner, corrections officer, healthcare staff, and inmate volunteer perspectives	Themes: Patient centred care The inmate hospice volunteer model Safety and security Shared values Teamwork The importance of healthcare staff, corrections officers, volunteers and prisoners working together is emphasised. The inmate hospice volunteer model is described as being essential to the success of the hospice.	Strengths: Question sufficiently described, evident and appropriate design, study context clear, sampling appropriate and well described, data collection appropriate and well described, data analysis appropriate and well described, verification procedures present, well-supported conclusions Limitations: Partial connection to theoretical framework, limited information on reflexivity Quality score: 85%
Cloyes et al 30 (2017) USA	Louisiana State Penitentiary prisoners, inmate hospice volunteers, healthcare staff and corrections officers (n=43)	Ethnographic case study/ interviews and observations	To describe how inmate hospice volunteers learn hospice care	Themes: Formal training and education/practical experience at the bedside Formal and informal peer mentorship Interactions with nursing and corrections staff Structured training, bedside experience, peer mentorship and support from nurses and corrections officers enable volunteers to become an invaluable part of the hospice team.	Strengths: Study context clear, sampling appropriate and well described, data collection appropriate and well described, data analysis appropriate and well described, verification procedures present, well-supported conclusions Limitations: Partial connection to theoretical framework, limited information on reflexivity Quality score: 80%
Depner et al 32 (2017) USA	Inmate hospice volunteers (n=22) from a maximum security prison in the north-eastern USA	Consensual qualitative research/ interviews	To explore the phenomenological perspective of inmates participating in inmate facilitated hospice care with regard to meaning and purpose in life, attitudes on death and dying, and the personal impact of participation	Themes: Confronting death and dying Personal growth and transformation Varied thoughts on death and dying and discussion of the impact exposure to death has on inmate hospice volunteers. Volunteers reflect on the impact their role has had on them, with discussion of personal growth and transformation, conceptualised as posttraumatic growth.	Strengths: Question sufficiently described, evident and appropriate design, study context clear, connected to theoretical framework, data collection appropriate and well described, data analysis appropriate and well described, verification procedures present, well-supported conclusions, reflexivity present Limitations: limited information on sampling Quality score: 95%
Depner et al 33 (2018) USA	Inmate hospice volunteers (n=22) from a maximum security prison in the north-eastern USA	Consensual qualitative research/ interviews	To (a) describe a prison-based end of life programme utilising inmate peer caregivers, (b) identify inmate caregiver motivations for participation and (c) analyse the role of building trust and meaningful relationships within the correctional end of life care setting.	Themes: Programme description Motivation Connecting with others Hospice programme was generally well regarded in the prison. There are numerous drivers for becoming a peer caregiver, including the idea of ‘giving something back’ or making amends for past wrongs. Connections are important, not only between carer and patient, but with family, friends and other inmates.	Strengths: Question sufficiently described, evident and appropriate design, study context clear, sampling appropriate and well described, data collection appropriate and well described, data analysis appropriate and well described, verification procedures present, well-supported conclusions, reflexivity present Limitations: Partial connection to theoretical framework Quality score: 98%
Handtke & Wangmo3 (2014) Switzerland	Older inmates in Swiss prisons (n=35)	Theoretical (Allmark’s concept of ‘death without indignities’)/ interviews	To investigate elderly prisoners' attitudes towards death and dying	Themes: Attitudes towards death and dying Experiences with other prisoners deaths and accounts of personal life-threatening situations Suicide and suicidal thoughts Realities of end of life services available in prison Importance of maintaining relationships with family and friends at the end of life Wishes to die outside prison Varied attitudes towards death and dying shaped by experiences of death. Palliative and end of life care service provision viewed as poor. Maintaining links to family is seen as important, and most prisoners were focussed on surviving their sentence to die outside.	Strengths: Study context clear, connected to theoretical framework, sampling appropriate and well described, data collection appropriate and well described, data analysis appropriate and well described, verification procedures present, well-supported conclusions Limitations: Partial description of question and overall design, limited information on reflexivity Quality score: 85%
Handtke et al 34 (2017) Switzerland	Older inmates in Swiss prisons (n=35)	Theoretical (Garland’s depiction of the criminology of the self and the criminology of the other)/ interviews	To (a) present opinions of older prisoners in Switzerland on early release on compassionate grounds, (b) to frame arguments against Garland's (1996) two criminologies of self and other, and (c) propose a middle way based on Garland's welfarist criminology and European human rights	Themes: Change in circumstances due to illness or old age Shared humanity A clash of beliefs and reality The prison environment is unsuitable for elderly prisoners, who are also less dangerous due to their age. People should be afforded the dignity to either be released or cared for properly in prison. While prisoners are optimistic about being released when they are nearing death, their past experiences are in conflict with this belief.	Strengths: Question sufficiently described, sampling appropriate and well described, data collection appropriate and well described, data analysis appropriate and well described, verification procedures present, well-supported conclusions Limitations: Limited information provided on design and the context for the study, as well as reflexivity Quality score: 83%
Lillie et al 35 (2018) UK	Health professionals from a specialist palliative care provider (n=10)	Pilot study/ focus group	To understand the challenges faced by community palliative care providers when caring for those in custody	Themes: Inpatients under prison, probation or police supervision altered the dynamics of care provision Prisoners as relatives Encountering offending behaviour in the home Only the first theme is relevant to this review. The concept of restraints being used in the hospice setting was discussed. It was acknowledged that it did not occur often, but was a negative experience for all concerned when it did. It was challenging to connect with the patient in this environment.	Strengths: Question sufficiently described, study context clear, well-supported conclusions Limitations: Limited information on design, sampling, data analysis and reflexivity, not linked to theoretical framework, very limited information on data collection and verification procedures Quality score: 55%
Loeb et al 36 (2014) USA	Current and potential users of palliative and end of life care services in a mid-Atlantic USA state (n=21)	Descriptive/ interviews	To examine the values, beliefs, and perceptions held by current and potential future consumers of end of life care in prisons to highlight the facilitators and barriers to providing compassionate care for those dying in prison.	Themes: Seeking human interaction Accessing material resources Obtaining compassionate care Seeking equitable care Addressing physiological needs Facing death. The prison environment and resources present significant challenges to accessing care that is equitable to that available outside, or even to meeting basic needs. Interacting with other people, and inmate volunteers were seen as important. Themes:	Strengths: Question sufficiently described, evident and appropriate design, study context clear, sampling appropriate and well described, data collection appropriate and well described, data analysis appropriate and well described, verification procedures present, well-supported conclusions Limitations: Limited information provided on reflexivity. Quality score: 88%
Marti et al 37 (2017) Switzerland	Prisoners, corrections officers, healthcare staff, representatives of prison authorities and a prison chaplain instructor (n=62)	Ethnographic/ multimethod (interviews, observations, case study reconstructions)	To answer the following questions: (1) What are the institutional logics of the prison system and how are these logics challenged by the logic of long-term geriatric and EOL care? (2) How do these institutional logics shape everyday practices of prison officers and how do they also question, resist, and transform them in their daily work activities?	Themes: Thornton and Ocasio’s (1999, 2008) ‘institutional logics’ perspective applied: Institutional Logics and Daily Practice: INTERinstitutional cases: care and custody must be balanced, some corrections officers exercise discretion in order to do this Institutional Logics and Daily Practice: INTRAinstitutional cases: the type of care delivered in prison is transitioning from curative to palliative. Corrections staff again acting outside role to meet the needs of prisoners.	Strengths: Question sufficiently described, evident and appropriate design, study context clear, connected to theoretical framework, well-supported conclusions Limitations: Partial information on sampling, data collection and data analysis, limited information on verification procedures and reflexivity Quality score: 65%
Peacock et al 38 (2017) UK	Mixed sample of prisoners, prison officers, healthcare staff and others involved in prison service (n=62)	Action research/ interviews, focus groups and observations	To discuss the concept of ‘jail craft’	Themes: Jail craft – an introduction Cost of benchmarking: resources and frustrations Prison officers and end of life care Discusses the concept of ‘jail craft’: a protective, nostalgic discourse adopted by prison officers in the face of increasing pressures on the service, both in relation to end of life care, and other political drivers.	Strengths: Question sufficiently described, evident and appropriate design, study context clear, connected to theoretical framework, data collection appropriate and well described, verification procedures present, well-supported conclusions Limitations: Limited information on sampling strategy and reflexivity Quality score: 78%
Penrod et al 39 (2014) USA	Central administrators for a state department of corrections (n=12)	Descriptive/ interviews	To describe perspectives of end of life care held by prison administrators in a state prison system to reveal challenges to changing practice in this area.	Themes: Centralised policy vs local prison culture Treatment vs security focus Case-by-case vs system-wide perspectives Needs vs public sentiment Budget neutral approaches vs demands on the system Inmate vs staff service Many challenges to be overcome when changing practice, including the conflict of care vs custody. Acknowledgement of the grief of prisoners, carers and correctional staff exposed to death in prison.	Strengths: Question sufficiently described, evident and appropriate design, study context clear, data collection appropriate and well described, data analysis appropriate and well described, verification procedures present, well-supported conclusions Limitations: Partial information on sampling strategy and limited information on reflexivity Quality score: 83%
Sanders & Stensland 40 (2018) USA	Prisoners nearing end of life in mid-western USA, who took part in an anticipatory care planning (ACP) session (n=20)	Qualitative (unspecified)/ observation of ACP session	To report on the inmate experience of approaching death in prison	Themes: Losing a piece of everything Not sure what to feel Where will I die? Finding purpose in the midst of purposelessness Preparing for the inevitable Inmates experienced a range of emotions and reactions to approaching death. Many felt strongly that they did not want to die in prison or be buried on prison property. Importance was placed on things that provide meaning, such as religion, family, prison jobs and small things like TV.	Strengths: Question sufficiently described, study context clear, data collection appropriate and well described, data analysis appropriate and well described, verification procedures present, well-supported conclusions Limitations: Partial information on design, connection to theoretical framework, and reflexivity Quality score: 83%
Sanders et al 41 (2018) USA	Prisoners nearing end of life in mid-western USA, who took part in an ACP session (n=20)	Theoretical (Bandura’s agentic perspective)/ observation of ACP session	To develop insight about the opportunities and needs of offenders in directing the end of life care they receive and the dying process that they ultimately experience, which an agentic perspective facilitates.	Discussed with reference to Bandura’s agentic perspective (2006). Themes: What works best for me Feeling blessed Decisions in the shadows of the past What is really going on? Can anyone be trusted? Turning agency over to someone else Some aspects of ACP planning enacted agency and made prisoners feel positive. Others were suspicious. Despite all wishing to have a proxy decision maker for when they became too unwell, only a small amount could identify anyone outside of prison to adopt this role.	Strengths: Question sufficiently described, study context clear, connected to theoretical framework, sampling appropriate and well described, data collection appropriate and well described, data analysis appropriate and well described, verification procedures present, well-supported conclusions Limitations: Partial information on overall design and reflexivity Quality score: 90%
Supiano et al 42 (2014) USA	All hospice volunteers in Louisiana State Penitentiary (n=36)	Descriptive/ interviews	To answer the following: (1) How do inmates recall death experiences that occurred prior to their entry into the hospice volunteer role? (2) How do volunteers describe the meaning of these deaths and any impact on their volunteer work? (3) How do volunteers describe the experience of caring for dying inmates? (4) Are these deaths associated with grief in the volunteers, and how is this grief addressed?	Themes: Experience with death Death of patients in hospice care The grief of hospice volunteers Volunteers had varied responses to death, but perceived their role as essential in supporting the dying in the hospice. They were confronted by their own mortality when patients died. They experienced profound grief, and coped with it through various mechanisms, including spirituality, throwing themselves into work and peer support.	Strengths: Question sufficiently described, evident and appropriate design, study context clear, sampling appropriate and well described, data collection appropriate and well described, data analysis appropriate and well described, verification procedures present, well-supported conclusions Limitations: Partial acknowledgement of reflexivity Quality score: 90%
Turner et al 4 (2018) UK	Interviews with mixed correctional and healthcare staff and prisoners (n=64) and survey of elderly prisoners (n=127)	Mixed methods action research/ survey and interviews	To understand the social processes at work in a prison setting and how they impact on the provision of health and social care for ageing and dying prisoners	Themes: Frailty and vulnerability Prison environment and resources The prison environment is not suited to the increasingly large population of elderly prisoners, many of whom are fearful of the younger prisoners. Survey findings: Total population of 202 prisoners older than 55 were surveyed. 62.9% responded (n=127). Mean age 65, oldest prisoner 91. 75% are in prison for the first time. 28.4% rate their health as very poor. 22% have five or more health conditions. 55.9% have three or more health conditions. 91% have at least one condition. 49.6% are on at least five drugs, 89% are on at least 1. 26% can’t walk 100 m. 18.9% can’t manage stairs. 30.7% had a fall within the last 2 years. 72% older prisoners would like to be housed separately to younger prisoners	Strengths: Question sufficiently described, evident and appropriate design, study context clear, data collection appropriate and well described, well supported conclusions Limitations: Limited information on verification procedures and reflexivity Quality score: 73%