This study investigated the psychological impact of autopsy imaging (Ai) on bereaved families of patients with terminal cancer. These patients, one with pancreatic cancer of the body and tail and the other with intrahepatic cholangiocarcinoma, underwent Ai, and a mixed-methods survey was conducted with 7 bereaved family members using a self-administered questionnaire. Although the awareness of Ai was low (14.3%), all participants reported that Ai helped them understand the cause of death. Moreover, 71.4% felt that Ai was necessary. Qualitative analysis of free-text responses suggested that Ai contributed to a clearer understanding and acceptance of the cause of death and provided psychological reassurance. On the other hand, it became evident that the implementation of Ai could evoke emotional conflict and complex feelings in bereaved families. Therefore, confirming the patient’s wishes and providing psychological support to both the patient and their family are essential when conducting Ai. In the future, it will be essential for medical professionals to carefully explain the purpose and significance of Ai during advance care planning discussions, and to consider its implementation while respecting the wishes of both the patient and their family.