Patients' Sense of Security During Palliative Care—What Are the Influencing Factors? 

Journal of Pain and Symptom Management
Volume 48, Issue 1 , Pages 45-55, July 2014

• Anna Milberg, MD, PhD
,
• Maria Friedrichsen, RN, PhD
,
• Maria Jakobsson, MD
,
• Eva-Carin Nilsson, RN
,
• Birgitta Niskala, RN
,
• Maria Olsson, RN
,
• Rakel Wåhlberg, RN
,
• Barbro Krevers, ROT, PhD

Accepted 31 August 2013. published online 05 May 2014.

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Abstract 

Context

Having a sense of security is vitally important to patients who have a limited life expectancy.

Objectives

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.

Conclusion

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.

Key Words: Sense of security, palliative, patient, mastery, stress, attachment, social support, quality of life