• Marie Locatelli, Léonor Fasse, Céline Lacombe, and Cécile Flahault.
• Laboratoire de psychopathologie et processus de santé, Université Paris Cité, 71 avenue Edouard Vaillant, Boulogne-Billancourt, France. Electronic address: marie.locatelli@etu.u-paris.fr.
• J Pain Symptom Manage. 2025 Feb 11.

BackgroundContinuous deep sedation until death (CDS) is a procedure commonly used in palliative care to alleviate refractory symptoms in terminally ill patients. This systematic review aims to explore the experiences of both healthcare providers (HCPs) and relatives regarding the use of CDS, highlighting emotional, ethical, and practical implications.MethodsA systematic search was conducted in six electronic databases (Embase, PsycINFO, PubMed, Scopus, Web of Science, Cairn). Studies were included if they focused on the experiences of HCPs and/or relatives related to CDS in terminally ill adults. The Crowe Critical Appraisal Tool (CCAT) was used to assess the quality in the included studies.ResultsA total of 40 studies were included, comprising 9260 HCPs and 1062 relatives. The review identified four main themes: decision-making processes, emotional and psychological adjustment, ethical concerns regarding the distinction between CDS and medical assistance in dying and communication challenges. CDS was found to contribute to a "good death" from the perspective of many relatives, though concerns about hastening death were noted. Healthcare providers reported mixed emotions, including ethical dilemmas and emotional burden when administering CDS. Communication issues between families and healthcare teams were highlighted as key challenges.ConclusionsCDS can alleviate suffering but raises ethical and communication challenges for both families and healthcare providers. Clearer guidelines, enhanced support systems, and improved communication strategies are essential for better CDS practices.Copyright © 2025. Published by Elsevier Inc.

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