title: Patients' sense of security during palliative care-what are the influencing factors?
abstract: BACKGROUND
  Having a sense of security is vitally important to patients who have a limited life expectancy.
  
  
  OBJECTIVE
  We sought to identify the factors associated with patients' sense of security during the palliative care period.
  
  
  METHODS
  We recruited 174 adult patients (65% of those eligible) from six palliative home care units. The relationship between the patients' sense of security during palliative care and individual factors was evaluated in a stepwise procedure using the generalized linear model (ordinal multinomial distribution and logit link).
  
  
  RESULTS
  Respondents' ratings of their sense of security ranged from 1 (never) to 6 (always), with a mean value of 4.6 (SD 1.19). Patients with lower feelings of security experienced higher stress; more worry about personal finances; lower feelings of self-efficacy; a lower sense of security with the palliative care provided (lower ratings on subscales of care interaction); mastery; prevailed own identity; higher symptom intensity (especially depression, anxiety, and lack of well-being); lower health-related quality of life; lower attachment anxiety and avoidance; less support from family, relatives, and friends; lower comfort for those closest to them; and more often had gynecological cancer. Six variables (mastery, nervousness and stress, gynecological cancer, self-efficacy, worrying about personal finances, and avoidance) were selected in building the stepwise model.
  
  
  CONCLUSIONS
  These findings stress the importance of palliative care services in supporting dying patients' sense of security through symptom management with a wide scope and through supporting the patients' sense of mastery, identity, and perception of a secure care interaction and also through attention to the family members' situation.
authors.affiliation: Department of Social and Welfare Studies, Linköping University, Linköping, Sweden; Palliative Education and Research Centre in the County of Östergötland, Norrköping, Sweden; Department of Advanced Home Care, LAH Öst, County of Östergötland, Norrköping, Sweden. Electronic address: anna.milberg@liu.se.
authors.forename: Anna
authors.initials: A
authors.lastname: Milberg
authors.affiliation: Department of Social and Welfare Studies, Linköping University, Linköping, Sweden; Palliative Education and Research Centre in the County of Östergötland, Norrköping, Sweden.
authors.forename: Maria
authors.initials: M
authors.lastname: Friedrichsen
authors.affiliation: Palliative Education and Research Centre in the County of Östergötland, Norrköping, Sweden; Department of Advanced Home Care, LAH Öst, County of Östergötland, Norrköping, Sweden.
authors.forename: Maria
authors.initials: M
authors.lastname: Jakobsson
authors.affiliation: Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Eva-Carin
authors.initials: EC
authors.lastname: Nilsson
authors.affiliation: Ryd Primary Health Care Center, Linköping, Sweden.
authors.forename: Birgitta
authors.initials: B
authors.lastname: Niskala
authors.affiliation: PRIVO/Palliative Consulting Team, Northern County of Kalmar, Oskarshamn, Sweden.
authors.forename: Maria
authors.initials: M
authors.lastname: Olsson
authors.affiliation: Department of Advanced Home Care, LAH Öst, County of Östergötland, Norrköping, Sweden.
authors.forename: Rakel
authors.initials: R
authors.lastname: Wåhlberg
authors.affiliation: Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Barbro
authors.initials: B
authors.lastname: Krevers
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005190:Family; D006699:Home Care Services; D006801:Humans; D007407:Interviews as Topic; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000523:psychology*; D011788:Quality of Life; D012944:Social Support; D013315:Stress, Psychological
keywords: Sense of security; attachment; mastery; palliative; patient; quality of life; social support; stress