Supportive and Palliative Care Indicators Tool (SPICT): An international approach to identifying patients for palliative care

Dr Kirsty Boyd and Professor Scott Murray, the SPICT project leaders, explain how this increasingly popular tool is being used internationally by clinicians to identify people for integrated palliative care.

Dr Kirsty Boyd

Dr Kirsty Boyd

Late identification of people dying with one or more advanced conditions is the main reason why most people throughout the world do not receive the palliative approach to their care, which can make such a difference. Every clinician must be able to recognise when palliative care can be of benefit. Population estimates suggest that 69%–82% of people who die in economically developed countries could benefit from integrated palliative care. About 1-2% of people living in the community and around 30% of hospital inpatients are likely to be in, or approaching, the last year of their lives. Better care of the increasing numbers of people dying with multiple advanced conditions (multimorbidity) depends on professionals in primary care teams, hospital specialists and a range of other health and social care professionals making earlier identification part of their routine clinical practice in all care settings.

Professor Scott Murray

Professor Scott Murray

The SPICT is a clinical tool developed originally in 2010 as a collaborative project between NHS Lothian and The University of Edinburgh Primary Palliative Care Research Group. It supports the professional judgement of individual clinicians and multidisciplinary teams by highlighting readily identifiable general indicators and clinical signs of deteriorating health that mean patients are at risk of deteriorating further and dying. Clinicians are prompted to consider these people for assessment of unmet holistic care needs and opportunities to talk about their health problems, the things that matter most to them and their families, and future care planning.

SPICT seeks to improve ‘prognostic awareness’ while addressing the ‘prognostic paralysis’ that sometimes means palliative care is only offered when there are no other treatment options and the patient is close to dying. An individual patient’s risk of dying is multifactorial, relative and changes over time. The SPICT approach to timely identification acknowledges this variability and does not require a decision to be made about whether a patient is likely to die within a given time frame. General indicators, such as unplanned hospital admissions and increasing care needs, are evidence of deterioration in the person’s general health. These are combined with indicators of progressive, advanced illness drawn from a wide range of disease-specific mortality scores and other prognostic tools. The SPICT is based on expert consensus about the most appropriate indicators for use in routine clinical practice. SPICT has been formally evaluated in primary care and in hospitals and is now in use in all care settings.

spictJoin the SPICT community…
Open access to the current version of the SPICT on the SPICT website has encouraged a growing community of international collaborators to contribute to ongoing peer review and refinement. Our website offers short guides to using SPICT in primary care and in hospitals and you can download the SPICT in English, French, German and Spanish. Dutch, Portuguese and Japanese translations are under way. SPICT partners around the world can post information about their projects on using SPICT in clinical practice and research. Online communities of SPICT collaborators are available in English, French and German. The EAPC Taskforce in Primary Palliative Care has recommended SPICT for use across Europe. A recent, online survey of users rated key aspects of SPICT: available on a single page (89%), uses clinical indicators (93%), applicable in community, hospital and hospice settings (81%), promotes early, integrated palliative care (83%).

‘SPICT is clear, credible and can be used in all care settings.’

Join the SPICT community, an international partnership of colleagues dedicated to getting palliative care integrated into the care of people with all chronic progressive illnesses as early as possible!

Highet G, Crawford D, Murray SA, Boyd K. Development and evaluation of the Supportive and Palliative Care Indicators Tool (SPICT): a mixed-methods study. BMJ Support Palliat Care Published Online First: 25 July 2013 doi:10.1136/bmjspcare-2013-000488.

Maas E, Murray SA, Engels Y, Campbell C. What tools are available to identify people with palliative care needs in primary care: a systematic review and survey of European practice. BMJ Support Pall Care 2013;3:444–451.

Sulistio M, Franco M, Vo A, Poon P, Leeroy W. Hospital rapid response team and patients with life-limiting illness: a multicentre, retrospective cohort study. Palliat Med 2015;29(4):302-309.

Read more on the EAPC Blog…
You can read more posts from Professor Scott Murray here.

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