Patient altruism at the end of life: A scoping review

Anca-Cristina Sterie; Gian Domenico Borasio; Michael J Deml; Claudia Gamondi; Ralf J Jox; Philip Larkin; Alexia Trombert; Eve Rubli Truchard; Mathieu Bernard

doi:10.1017/S1478951524000361

Patient altruism at the end of life: A scoping review

Palliat Support Care. 2024 Apr 12:1-13. doi: 10.1017/S1478951524000361. Online ahead of print.

Authors

Affiliations

¹ Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
² Chair of Geriatric Palliative Care, Service of Palliative and Supportive care and Service of Geriatrics and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
³ Institute of Humanities in Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
⁴ Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland.
⁵ Chair of Palliative Care Nursing, Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
⁶ Medical Library, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.

PMID: 38605652
DOI: 10.1017/S1478951524000361

Abstract

Objectives: The concept of altruism is evidenced in various disciplines but remains understudied in end-of-life (EOL) contexts. Patients at the EOL are often seen as passive recipients of care, whereas the altruism of professionals and families receives more research and clinical attention. Our aim was to summarize the state of the scientific literature concerning the concept of patient altruism in EOL contexts.

Methods: In May 2023, we searched 11 databases for scientific literature on patient altruism in EOL contexts in consultation with a health information specialist. The scoping review is reported using the PRISMA checklist for scoping reviews. We used a data charting form to deductively extract data from the selected articles and then mapped data into 4 themes related to our research questions: how authors describe and employ the concept of patient altruism; expressions of patient altruism; consequences of patients' altruistic acts; and possible interventions fostering patient altruism.

Results: Excluding duplicates, 2893 articles were retrieved; 33 were included in the final review. Altruism was generally considered as an act or intention oriented toward the benefit of a specific (known) or non-specific (generic) recipient. Patients expressed altruism through care and support, decisions to withhold treatment or actively hasten death, and engagement in advance care planning. Consequences of altruism were categorized in patient-centered (contribution to meaning in life and quality of life), non-patient-centered (leaving a positive impact and saving money), and negative consequences (generating feelings of guilt, exposing individuals with low self-esteem). Interventions to encourage altruism comprised specific interventions, providing opportunities to plan for future care, and recognizing and respecting the patients' altruistic motivations.

Significance of results: We identified heterogeneous and limited research conceptualization of patient altruism and its operationalization in palliative care settings. A deeper conceptual, empirical, and theoretical exploration of patient altruism in EOL is necessary.

Keywords: Altruism; end of life; palliative care; patients; scoping review.

Publication types

Review