Objective To systematically synthesize the decision-making experiences of cancer patients and their family caregivers during the selection of vascular access devices (VADs), thereby providing evidence to inform the development of shared decision-making interventions. Methods A comprehensive search was conducted across domestic and foreign databases for qualitative studies regarding decision-making experiences of cancer patients and their family caregivers during the selection of VADs from inception to December 2025. A convergent meta-synthesis approach was employed to integrate and analyze qualitative findings. Results Fourteen studies were included, from which 50 discrete findings were extracted and grouped into 12 categories. These categories were further synthesized into five overarching themes:pre-decision emotional and cognitive experiences; factors influencing decision-making; patterns of decision-making participation; experience on the use of VADs after decision-making; and needs for decision support and opportunities for optimization. Conclusion The process of selecting VADs among cancer patients and their caregivers is complex and shaped by multiple factors. Clinical practice should prioritize the development of patient-centered decision aids, strengthen multidimensional support systems, and streamline care pathways to improve the decision-making experience of tumor patients and their caregivers.