Objective To systematically review and synthesize qualitative studies examining patient and family involvement in advance care planning (ACP) in the context of end-stage renal disease (ESRD), and to provide reference for implementation of ACP in ESRD patients and their families. Methods To identify qualitative studies focusing on patient and family involvement in ACP in the context of ESRD, we conducted a systematic literature search in PsycINFO, PubMed, Cochrane Library, Web of Science, CNKI, CBM, WanFang Data, and VIP, from their respective inception through August 2022. Results Eleven articles met the eligibility criteria.A total of 45 research results were extracted, 16 categories were formed, and then 4 themes were identified:attitudes toward ACP, experience of involvement in ACP, factors influencing their involvement, and suggestions for implementation of ACP. Conclusion ESRD patients and families had insufficient knowledge and impaired perceptions of ACP, and there was a gap between desire and reality. They also expressed that practice of ACP was affected by many factors. Medical staff need to strengthen support to meet their desire for involvement in ACP.