Psychological adjustment and perception of patients’ relatives and healthcare providers regarding continuous deep sedation until death: A mixed-methods study.

Abstract

12098 Background: France is currently in the midst of societal discussions concerning new legislation on active assistance in dying. Continuous Deep Sedation Until Death (CDSUD) is considered by some a “French exception” since 2016, but 8 years later, findings suggest that this procedure is not really clear to all, including patients, their relatives and their healthcare providers (HCP). The primary objective of this original research is to document the psychological adjustment of patients’ relatives and HCPs in the cancer context. Methods: APSY-SED (ID-RCB 2021-A03042-39) is a multicentric prospective, longitudinal and observational study, using a mixed-methods design. A lexicometric analysis of the semi-structured interviews was performed using Iramuteq software. A questionnaire survey was conducted, encompassing for relatives: anxiety and depressive symptoms (STAI-S, BDI-II); for HCPs: Professional Stress and Professional experience (Karasek questionnaire). We present here the main results at T1 (when CDSUD is implemented). Results: Main quantitative results are presented in Table I. Regarding qualitative findings, fifteen research interviews with relatives and 15 interviews with HCP were analyzed. Most frequent words associated with CDSUD were its “objectives”, its specific “temporality”, the mention of “euthanasia”, and “saying goodbye”. Confusion between CDSUD and euthanasia persists in relatives and HCPs. Conclusions: On average, relatives reported severe anxiety in the context of CDSUD. The qualitative findings regarding the main concerns shared by the relatives concerning the CDSUD temporality perceived as brutal, shed light on this anxiety. The second assessment time of this study, 6 months after death, including measures of depression, anxiety, intensity of grief reactions, will allow to specify the adjustement at mid-term. This is the first empirical study carried out in France on the adjustment of relatives and HCPs caring for patients with cancer for whom CDSUD is discussed. [Table: see text]