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Upside down solutions: palliative care and COVID-19
  1. Daniel Knights1,
  2. Felicity Knights2 and
  3. Iain Lawrie3,4
  1. 1 Department of Palliative Care, Imperial College Healthcare NHS Trust, London, UK
  2. 2 The Population Health Research Institute, St George's, University of London, London, UK
  3. 3 Department of Palliative Medicine, North Manchester General Hospital, Manchester, UK
  4. 4 Manchester Medical School, University of Manchester, Manchester, UK
  1. Correspondence to Dr Daniel Knights, Department of Palliative Care, Imperial College Healthcare NHS Trust, Room 6L07, Charing Cross Hospital, London, W6 8RF, UK; dan.knights{at}


The current COVID-19 pandemic is unprecedented and requires innovation beyond existing approaches to contribute to global health and well-being. This is essential to support the care of people at the end of their lives or who are critically ill from COVID-19 or other life-limiting illnesses. Palliative care (PC) is centred on effective symptom control, promotion of quality of life, complex decision-making, and holistic care of physical, psychological, social and spiritual health. It is ideally placed to both provide and contribute to care for patients, families, communities and colleagues during the pandemic. Where recovery is uncertain, emphasis should be on care and relief of suffering, as well as survival. Where healthcare resources and facilities come under intense pressure, lessons can be learnt from models of care in other settings around the world. This article explores how the field can contribute by ensuring that PC principles and practices are woven into everyday healthcare practice. We explore alternative ways of providing care under such pressure and discuss three areas of learning from resource-limited settings: (1) integration of palliative medicine into everyday practice, (2) simplification of biomedical management plus multidisciplinary teamwork and (3) effective use of volunteers.

  • education and training
  • communication
  • clinical assessment
  • family management
  • hospital care
  • psychological care

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data availability statement There are no original data in this work.