Deprescribing decisions in palliative care: a qualitative meta-synthesis of multi-stakeholder experiences and influencing factors

Deprescribing decisions in palliative care involve complex interactions among multiple stakeholders, yet the experiences and needs of those involved remain poorly understood and lack systematic integration. This review aims to synthesize qualitative evidence on the experience, needs and influencing factors of multi-stakeholder in deprescribing decisions within palliative care, and to identify the core challenges faced in clinical practice. A systematic review and meta-synthesis of qualitative studies. Six electronic databases (PubMed, CINAHL, EMBASE, Web of Science, CNKI, and Wanfang) were searched from inception to November 8, 2025. The search strategy combined terms related to deprescribing, palliative care, and qualitative research. Two reviewers independently screened titles, abstracts, and full texts against predefined inclusion criteria. Quality appraisal was conducted using the Joanna Briggs Institute (JBI) checklist for qualitative research, and data were synthesized using thematic integration. The review followed ENTREQ guidelines for reporting. Eight studies from four countries were included, exploring deprescribing experiences and needs of patients, family caregivers, and healthcare professionals. Thematic synthesis generated four overarching themes: complexity of decision-making, role variations among multiple-stakeholders, Communication strategies and trust-building, healthcare system and environment barriers. Effective communication among multiple-stakeholders is critical for addressing deprescribing challenges in palliative care. The differences in stakeholders' priorities and the barriers between the healthcare system and the environment are common challenges that need to be faced. These experiences and demands affect the appropriateness and feasibility of deprescribing decisions, and have a significant impact on optimizing deprescribing practices in palliative care, improving the quality of life and care delivery.