Background: Pancreatic cancer is a less survivable cancer, with most people diagnosed at an advanced stage, facing poor prognoses; five-year survival rates are <5% overall and <1% when tumours are inoperable. Consequently, people with pancreatic cancer face significant psychosocial challenges and psychological morbidity. However, there has been no review and synthesis of literature on the psychosocial aspects of their experiences across the illness trajectory. Aim: To identify, analyse, and synthesise literature answering the research question: ‘What are the psychosocial aspects of people’s experiences when receiving, living, and dying with (or surviving) a diagnosis of pancreatic cancer?’ Methods: This qualitative systematic review (CRD42025635882) was guided by PRISMA 2020 guidelines. Seven databases (CINAHL, Embase, MEDLINE, PsycINFO, Scopus, Web of Science, and the WHO Global Index Medicus) were searched from their inception until March 2025. Of 6,861 records screened, 28 studies met inclusion criteria. Results: Included studies were published 1999–2025, 24 in the past decade. Each stage of the illness trajectory was addressed but most papers explored experiences relating to treatment and post-treatment. Four key themes were identified: (1) psychological distress relating to a) the shock of diagnosis, b) fear, anxiety, and uncertainty, and c) changes in identity and social roles; (2) the impact of symptom experiences on quality of life and social life; (3) coping mechanisms and sources of support, relating to a) family support, b) hope, faith, and spirituality, and c) the health care team; and (4) information needs, communication, and decision-making. Conclusions: This review highlights the profound psychosocial challenges encountered by people with pancreatic cancer across the illness trajectory, reinforcing the importance of interventions that alleviate distress, improve quality of life, and support coping. This review's insights can guide future research and inform interventions which support people's complex needs as they navigate the difficulties of a pancreatic cancer journey.