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J Pain Symptom Manage. 2019 Apr;57(4):809-815. doi: 10.1016/j.jpainsymman.2018.12.335. Epub 2018 Dec 27.

"No One Wants to Die Alone": Incarcerated Patients' Knowledge and Attitudes About Early Medical Release.

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The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
University of California San Francisco, Division of Geriatrics, San Francisco, California, USA.
Icahn School of Medicine at Mount Sinai, New York City, New York, USA.
University of California San Francisco, Division of Geriatrics, San Francisco, California, USA. Electronic address:



Deaths among incarcerated individuals have steadily increased in the U.S., exceeding 5000 in 2014. Nearly every state has a policy to allow patients with serious life-limiting illness to apply for release from prison or jail to die in the community ("early medical release"). Although studies show these policies are rarely used, patient-level barriers to their use are unknown.


To assess incarcerated patients' knowledge of early medical release policies and to identify patient-level barriers to accessing these policies.


A cross-sectional survey of 46 male patients in two state prisons and one large urban jail who had visited a primary care provider at least three times within three months was conducted.


Participants' average age was 64 years, and 89% had more than one chronic illness. Fewer than half (43%) demonstrated the knowledge needed to apply for early medical release and 22% demonstrated no relevant knowledge. Participants with sufficient knowledge were significantly more likely to endorse anxiety (35% vs. 0%, P = .003) and loneliness (65% vs. 30%, P = .017).


Many medically complex incarcerated patients in this study did not demonstrate sufficient knowledge to apply for early medical release suggesting that patient education may help expand access to these policies. Moreover, seriously ill patients with knowledge of early medical release may benefit from enhanced psychosocial support given their disproportionate burdens of anxiety and loneliness. Our findings highlight the pressing need for larger studies to assess whether improved patient education and support can expand access to early medical release.


Prison; complex care; palliative care; serious illness; vulnerable populations

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