82 Delivering specialist palliative care to an inmate in a high-security prison: a reflective case study

<h3>Background</h3> The prison population over 60 has more than tripled in the last two decades, with 90% having at least one significant health condition.¹ Providing palliative care in prisons is critical but faces unique challenges, often failing to meet inmate expectations.² Structural and organizational barriers delay care delivery, reducing access. We present a case highlighting symptom management through collaboration between palliative care team and the prison medical wing. <h3>Case Presentation</h3> A, 57, was diagnosed with tonsillar cancer 18 months ago and declined chemoradiotherapy. He was referred to our team for end-of-life symptom management. He experienced severe neuropathic pain, difficulty swallowing, facial swelling, and faced the risk of a catastrophic bleed. <h3>Management and Outcomes</h3> His care was jointly managed by community palliative care team and hospice team. After completing a risk assessment, he had a brief stay in the hospice. The palliative care team also visited him in prison after adhering to the necessary security protocols. Initially, his symptoms were controlled with an opioid syringe driver and neuropathic agents, which were later transitioned to a patch. As his condition worsened and he lost the ability to swallow, he was restarted on the syringe driver to meet additional opioid requirements. In addition to morphine, clonazepam was administered subcutaneously. He developed delirium and terminal agitation, which were managed with midazolam. The medical wing staff were trained to handle a potential catastrophic bleed, and all necessary medications were provided. He died peacefully in the medical wing, and the staff felt well-supported in managing his care. <h3>Results and Conclusion</h3> This case demonstrates how collaboration between community palliative care team, hospice, and criminal justice system enabled the delivery of individualized end-of-life care for the patient, allowing him to remain in his preferred place. We are now working on developing standard operating procedures for the future care of similar patients. <h3>References</h3> Hospice UK. Dying Behind Bars: How can we better support people in prison at the end of life. Hospice UK. 2021. Schaefer I, DiGiacomo M, Heneka N, Panozzo S, Luckett T, Phillips JL. Palliative care needs and experiences of people in prison: A systematic review and meta-synthesis. <i>Palliative medicine</i> 2022;<b>36</b>(3):443–61.