•Physicians’ death anxiety does not seem to relate to avoidant communication and decision-making.•Death anxiety does seem to make end-of-life care more difficult for physicians.•Education focused on death competence may support physicians caring for patients at the end of life. To examine the relationship between physicians’ death anxiety and medical communication and decision-making. It was hypothesized that physicians’ death anxiety may lead to the avoidance of end-of-life conversations and a preference for life-prolonging treatments. PubMed and PsycInfo were systematically searched for empirical studies on the relation between physicians’ death anxiety and medical communication and decision-making. This review included five quantitative and two qualitative studies (N = 7). Over 38 relations between death anxiety and communication were investigated, five were in line with and one contradicted our hypothesis. Physicians’ death anxiety seemes to make end-of-life communication more difficult. Over 40 relations between death anxiety and decision-making were investigated, three were in line with and two contradicted the hypothesis. Death anxiety seemes related to physicians’ guilt or doubt after a patient’s death. There was insufficient evidence to confirm that death anxiety is related to more avoidant communication or decision-making. However, death anxiety does seem to make end-of-life communication and decision-making more difficult for physicians. Education focused on death and dying and physicians’ emotions in medical practice may improve the perceived ease with which physicians care for patients at the end of life.