Cript Author Manuscript FindingsFive central categories emerged from analysis of interviews and other case-study data: patient-centered care, the volunteer model, safety and security, shared values, and teamwork. These categories are foundational Lixisenatide web components of the core category essentials of sustainable prison hospice as they were recounted by the COs, hospice staff and inmate volunteers. In what follows we present overarching features of these five essential categories, including similarities and differences associated with differing LSP hospice program roles, and provide tables linking their core components with definitions and exemplary quotes. Patient-Centered Care One of the first essential cross-cutting concepts identified was patient-centered care. This is a familiar term to many health providers across multiple settings, yet it assumes a different constellation of meanings in relation to end-of-life care in a prison hospice. Table 1 summarizes the four key concepts that describe the dimensions of patient-centered care and its meaning within this context: unconditional care, responsiveness, authentic relationships and knowing your patient.Am J Hosp ML240 biological activity Palliat Care. Author manuscript; available in PMC 2016 May 01.Cloyes et al.PageUnconditional care–Unconditional care was a critical component identified by all three groups, although how each group conceptualized it depended on their primary role and how closely they interacted with hospice patients. Many hospice staff and COs shared the view that a patient’s incarceration was their just punishment, not the adequacy of treatment or care they received while incarcerated. Inmate volunteers described unconditional care in terms of providing care of equally high quality to all their patients, regardless of race, social affiliation, religious belief (or non-belief), criminal history or personal characteristics. Responsiveness–Hospice staff, including CNAs, LPNs, and RNs, described patientcentered care as a patient-specific approach to addressing patient needs, including proactive symptom management based on expert assessment, responding to individual needs whenever possible, and patient advocacy. Staff also described a willingness among medical staff, volunteers and COs to change scheduling or unit routines in order to accommodate patient needs. Forming real relationships–Mentioned most often by the volunteers, forming real relationships meant being fully present when at the bedside and engaged in patient care. This was supported by establishing trust with patients (and staff), while maintaining appropriate boundaries. The prison setting presents barriers to COs and staff having such relationships with hospice patients, and volunteers were better suited to this role; staff and COs recognized the importance of these relationships and the commitment of volunteers in fostering them. Knowing your patient–This was described by volunteers as a critical lesson learned through experience, and by watching other volunteers in “a continuing process of learning” though which they understood the critical need to get to know and communicate with patients before they become too ill to engage. The need to have extensive understanding of each hospice patient as an individual was described in ethical terms, as essential for the provision of optimal care. The Inmate Hospice Volunteer Model The volunteer model was recognized by staff, COs, and volunteers as a critical and unique component of the LSP Prison.Cript Author Manuscript FindingsFive central categories emerged from analysis of interviews and other case-study data: patient-centered care, the volunteer model, safety and security, shared values, and teamwork. These categories are foundational components of the core category essentials of sustainable prison hospice as they were recounted by the COs, hospice staff and inmate volunteers. In what follows we present overarching features of these five essential categories, including similarities and differences associated with differing LSP hospice program roles, and provide tables linking their core components with definitions and exemplary quotes. Patient-Centered Care One of the first essential cross-cutting concepts identified was patient-centered care. This is a familiar term to many health providers across multiple settings, yet it assumes a different constellation of meanings in relation to end-of-life care in a prison hospice. Table 1 summarizes the four key concepts that describe the dimensions of patient-centered care and its meaning within this context: unconditional care, responsiveness, authentic relationships and knowing your patient.Am J Hosp Palliat Care. Author manuscript; available in PMC 2016 May 01.Cloyes et al.PageUnconditional care–Unconditional care was a critical component identified by all three groups, although how each group conceptualized it depended on their primary role and how closely they interacted with hospice patients. Many hospice staff and COs shared the view that a patient’s incarceration was their just punishment, not the adequacy of treatment or care they received while incarcerated. Inmate volunteers described unconditional care in terms of providing care of equally high quality to all their patients, regardless of race, social affiliation, religious belief (or non-belief), criminal history or personal characteristics. Responsiveness–Hospice staff, including CNAs, LPNs, and RNs, described patientcentered care as a patient-specific approach to addressing patient needs, including proactive symptom management based on expert assessment, responding to individual needs whenever possible, and patient advocacy. Staff also described a willingness among medical staff, volunteers and COs to change scheduling or unit routines in order to accommodate patient needs. Forming real relationships–Mentioned most often by the volunteers, forming real relationships meant being fully present when at the bedside and engaged in patient care. This was supported by establishing trust with patients (and staff), while maintaining appropriate boundaries. The prison setting presents barriers to COs and staff having such relationships with hospice patients, and volunteers were better suited to this role; staff and COs recognized the importance of these relationships and the commitment of volunteers in fostering them. Knowing your patient–This was described by volunteers as a critical lesson learned through experience, and by watching other volunteers in “a continuing process of learning” though which they understood the critical need to get to know and communicate with patients before they become too ill to engage. The need to have extensive understanding of each hospice patient as an individual was described in ethical terms, as essential for the provision of optimal care. The Inmate Hospice Volunteer Model The volunteer model was recognized by staff, COs, and volunteers as a critical and unique component of the LSP Prison.