Title: End-of-Life Sedation and Gendered Grief Pathways: A Longitudinal Qualitative Study of Spouses Bereaved by Cancer.

Purpose This study investigates gendered trajectories of spousal grief following cancer within palliative care contexts, 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 over 18 months. Methods This longitudinal qualitative study is part of the AfterSedatio project. Twenty-two bereaved spouses (12 men, 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 reflexive thematic analysis, following Braun & Clarke’s framework. Results Gendered patterns emerged across time. At T0, women provided vivid, emotionally embodied accounts of bodily decline, emergency care, and CDSUD decision-making. In contrast, men offered more structured, pragmatic narratives focused on logistics, clinical details, and prior family losses. At T1, women reported heightened emotional vulnerability and intrusive end-of-life memories; men highlighted routine disruption and relational absence. By T2, women approached future planning cautiously, maintaining strong emotional bonds, while men re-engaged in social life and personal projects. Across genders, the quality of palliative communication and clarity about sedation practices shaped grief integration. Women showed markedly higher financial vulnerability after bereavement. Conclusion Gender shapes—but does not rigidly determine—grief trajectories after cancer-related spousal loss. 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.