End-of-life sedation and gendered narrative registers: a longitudinal qualitative study of spouses bereaved by cancer

Abstract Purpose This study investigates gendered narrative registers in spousal grief following cancer, within this sample and interview context, in palliative care settings including continuous deep sedation until death (CDSUD). It examines (1) how men and women narrate and experience bereavement and (2) how their emotional, relational, and cognitive processes evolve across the first year of bereavement (3, 6, and 12 months post-loss). Methods This longitudinal qualitative study is part of the AfterSedatio project. Twenty-two bereaved spouses (12 men and 10 women) were interviewed at 3 (T0), 6 (T1), and 12 months (T2) after the loss of their partner. Interviews were analyzed using ALCESTE lexical analysis, complemented by a codebook (coding reliability) thematic analysis. Results Gendered patterns emerged across time. At T0, both men and women devoted substantial narrative space to the final days and the circumstances of the death, but in contrasting registers: women recounted these moments in sensorially detailed, emotionally embodied terms—bodily decline, acute care, and CDSUD decision-making—and framed the illness within the couple’s and the family’s biography, whereas men recounted the same period at greater emotional distance, in a factual register organised around clinical management, logistics, and prior family losses. At T1, the dominant classes for both genders were lexically weakly specified; within these, women’s accounts more often foregrounded emotional vulnerability and intrusive end-of-life memories and men’s routine disruption and relational absence. By T2, women tended to approach future planning cautiously and maintain strong emotional bonds, while men more often re-engaged in social life and personal projects. Across genders, the quality of palliative communication and clarity about sedation practices shaped grief integration. Women in this sample showed markedly higher financial vulnerability after bereavement. Conclusion Within this sample and interview context, gender was associated with distinct narrative registers in how bereavement was narrated after cancer-related spousal loss, registers that were fluid rather than fixed. Emotional, relational, and pragmatic registers evolve, underscoring the need for individualized, gender-sensitive bereavement support. End-of-life communication, particularly around sedation, plays a critical role in later grief adjustment.