End-of-Life Dreams and Visions in Dying Adults and Caregivers: A Systematic Review

End-of-life dreams and visions (ELDV) are commonly reported near death but remain poorly understood and inconsistently addressed in clinical care. This systematic review aimed to synthesize evidence on their prevalence, emotional impact, perceived meaning, and implications for end-of-life care. MEDLINE, Web of Science, and Scopus were searched to June 5, 2025, for English-language primary studies involving dying adults and/or family caregivers. Risk of bias was appraised, and findings were synthesized narratively because methodological heterogeneity precluded meta-analysis. Thirteen moderate-to-high-quality studies were included (Americas, n = 6; Europe, n = 4; Asia, n = 2; Australia, n = 1). ELDV prevalence ranged from 21% to 90% (unweighted mean 51.6%; sample-size-weighted mean 27.1%). Comfort was reported by an unweighted mean of 38.4% (range 24%–57.5%; weighted mean 26%), particularly when deceased loved ones appeared or when experiences involved journey or preparation-for-death motifs. Distress occurred in an unweighted mean of 25.3% (range 0%–54%; weighted mean 19.4%), especially when content revisited trauma, difficult relationships, or unresolved concerns. Qualitative findings identified reassurance, social support, reunion, and choice or control as sources of comfort, whereas existential concern and life review were linked to distress. ELDV were generally perceived as meaningful by patients and families. At minimum, one in five—and on average more than one in four—dying adults experience ELDV. Routine, nonjudgmental enquiry and supportive responses to distressing experiences may strengthen holistic end-of-life care. Future studies should use standardized definitions and measures, include culturally diverse populations, distinguish patient and caregiver perspectives, and evaluate targeted supportive interventions.