Relatives and Healthcare Providers' Psychological Adjustment at Continuous Deep Sedation Initiation

Abstract

Introduction: Deep and continuous sedation addresses the refractory suffering of patients expected to die in the short term. This practice creates a distinctive experience for both healthcare professionals and relatives. The objective of this study was to describe their psychological adjustment after caring for cancer patients for whom deep sedation was implemented.

Methods: APSY-SED is a multicenter, prospective, longitudinal study using mixed methods. This report focuses on quantitative data collected during the initial (T1) phase, at the onset of sedation. Relatives completed questionnaires assessing attachment style (RSQ), anxiety and depression (STAI-S, BDI-II), and satisfaction with end-of-life care (CANHELP). Healthcare professionals completed a job satisfaction questionnaire (Karasek questionnaire).

Results: The sample included 52 relatives and 46 healthcare professionals from five French hospitals. Satisfaction with needs negatively predicted depression (β = -2.68, P = 0.007). Anxiety was predicted by total CanHelp (β = 4.13, P = 0.004), but reduced by satisfaction with involvement (β = -1.84, P = 0.035) and relationship with doctors and nurses (β = -1.77, P = 0.008). ANOVA showed higher satisfaction when sedation was patient-initiated (P = 0.015). Among professionals, 19.6% reported job strain; job latitude was high (M = 76.83, SD = 7.57).

Discussion: These findings underscore the need for targeted emotional support for anxious relatives and highlight the protective role of satisfactory end-of-life care in mitigating depressive symptoms. Clear protocols and communication may help preserve high job satisfaction among healthcare professionals. Further longitudinal and qualitative research is necessary to clarify how these factors evolve over time within continuous deep sedation contexts.

Keywords: Deep sedation; emotional adjustment; healthcare providers; palliative care; relatives.