"I make myself very small in my corner": Purposeful Withdrawal as an Expression of Patient Altruism.

Background Altruism definition remains underexamined in end-of-life contexts. In palliative care, altruism may take new forms, especially when originating from patients. Understanding how patients perceive and express altruism is key to supporting their autonomy and sense of meaning.Aim To explore how palliative care patients understand and experience their own altruism, how it manifests in their relationships, and which forms of altruism they consider particularly meaningful at the end-of-life.Design Semi-structured interviews were conducted and analyzed using reflexive thematic analysis within a constructivist paradigm.Setting/participants Thirty-two palliative care patients (23 women), with an estimated life expectancy of six months or less and an average age of 68 years were recruited across the three major linguistic regions of Switzerland.Results Four interrelated themes were generated. Patients modified their altruistic engagement by "giving differently" and "giving less": everyday gestures became more deliberate and less frequent. They described actively "learning to receive altruism," experiencing an emotionally challenging shift from giver to recipient. Patients "set boundaries" to preserve themselves and be able to sustain altruism. Across themes, patients described a gradual process of purposefully withdrawing: reducing their visibility, minimizing their needs, and avoiding burdening others.Discussion Patients' sense of agency and reciprocity can be facilitated by recognizing their altruistic gestures and cultivating a relational climate based on authentic listening from their caregivers. The process of withdrawing may lead patients to minimize their needs to protect others. Clinicians are therefore invited to ensure that care addresses patients' unspoken needs while honoring their wish to give.