Cancer care in custody: health professional perspectives

BACKGROUND: The prison population is a uniquely disadvantaged group with complex healthcare needs. Australian prisons are currently facing overcrowding, and the number of older prisoners is growing. Humanitarian guidelines mandate equivalence of healthcare for prisoners, but evidence shows that prisoners face barriers at every stage of cancer care. OBJECTIVE: To explore the perceived challenges healthcare professionals (HCPs) face when treating prisoners with cancer. METHODS: This study used a qualitative, cross-sectional, exploratory design. Transcripts from seven focus groups with 24 HCPs from St Vincent's Hospital Melbourne were thematically analysed using a three-step coding process. HCPs were recruited based on their experience treating prisoners with cancer and included oncologists, oncology psychiatrists, radiation oncologists, surgeons, tumour stream and prison ward nurses, and prison medical staff. RESULTS: Though participants were motivated to provide optimal cancer care to prisoners, they faced several challenges, summarised by three key themes, which emerged from the data:, (1) Prisoner health is an informal specialty (learned on the job) (2) and the medical care of prisoners is difficult (3) communication with prisoners is different. CONCLUSION: This study reports on the unique challenges that HCPs face when treating prisoners with cancer. SIGNIFICANCE: HCPs would benefit from formal guidelines for treating prisoners with and improved communication between hospital and prison systems. There is a need for further research from the viewpoint of prisoners.