title: Protection against perceptions of powerlessness and helplessness during palliative care: the family members' perspective.
abstract: OBJECTIVE
  Resilience in relation to coping with stress, loss, and bereavement has recently received increased attention. The aim of the current study was to describe aspects that are experienced as a protection against powerlessness and/or helplessness during advanced palliative home care (APHC) or as a help when coping with such perceptions.
  
  
  METHODS
  Both family members during ongoing APHC and family members 3-9 months after the patient's death responded (in total, N = 233; response rate 72%) to a postal questionnaire with mainly open-ended questions. The text responses were analyzed using Manifest Content Analysis.
  
  
  RESULTS
  Protection against powerlessness and helplessness had been facilitated by a stable patient condition, the patient coping well, a trusting relationship with the patient, practical and emotional support from family and friends, access to palliative expertise, and staff support that was both individually-focused and cooperative. Other aspects that had helped or protected family members against powerlessness and helplessness were a belief that they had their own reliable knowledge to manage the difficult situation, talking to someone, doing good for the patient, distracting activities, acceptance, meaning and hope, and an inner feeling of security.
  
  
  CONCLUSIONS
  The findings are discussed in relation to existential psychology, the dual process model of coping with bereavement, and repressive coping. Clinical implications are suggested.
authors.affiliation: Department of Social and Welfare Studies, Linköping University, LAH/Unit of Palliative Care, University Hospital, Linköping, and Palliative Education and Research Centre in the County of Östergötland, Östergötland, Sweden. anna.milberg@isv.liu.se
authors.forename: Anna
authors.initials: A
authors.lastname: Milberg
authors.forename: Peter
authors.initials: P
authors.lastname: Strang
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001601:Bereavement; D005086:Existentialism; D005190:Family / Q000523:psychology*; D005260:Female; D006699:Home Care Services; D006801:Humans; D007389:Internal-External Control; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology; D010166:Palliative Care / Q000523:psychology*; D011209:Power, Psychological; D011795:Surveys and Questionnaires; D013548:Sweden; D055815:Young Adult