Using SPICT – presented by Dr Kirsty Boyd
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Why use SPICT™?SPICT™ is a clinical tool used by health and care professionals in many countries to help them identify people whose health is deteriorating due to one or more advanced, progressive conditions or a new life-threatening illness. Many of people (particularly if they have organ failure or multimorbidity) are still identified too late to benefit from well-coordinated palliative care integrated with appropriate treatment of their underlying illnesses. SPICT™ helps clinicians decide when it is time to look for unmet holistic care needs. We start talking with people and their families about what is important to them and the available treatment and care options. Planning ahead is important for people whose health is deteriorating gradually as well as for people at risk of an acute illness or complication of a long term condition.
Way to use SPICT™
Look at the people attending your clinic/ surgery or on your ward round. Look at people living in the care home you visit or at home. – use the SPICT™ indicators to help you decide if their health is deteriorating.
Review 3-5 people with SPICT™ general indicators who have one or more advanced conditions – start with people who are unstable and most at risk of deteriorating.
Use the SPICT™ indicators as a ‘checklist’ to screen a population of people in a care home, hospital or primary care area for further needs assessment.
Ask for a review of a person’s care by highlighting that they have SPICT™ indicators of deteriorating health and might benefit from care planning.
Use the SPICT™ or the SPICT-4ALL™ to help you open up a conversation with people about their health and care by referring to changes in an individual’s health and trying the communication tips in the SPICT Guides.
- SPICT™ has 6 general indicators of deteriorating health and increasing needs. They can be used alone to prompt an assessment or combined with the SPICT indicators of advanced, progressive conditions.
- SPICT™ is not a structured needs assessment tool so you may wish to combine it with other tools such as the Palliative Care Phase or the IPOS to decide the urgency of assessment and structure ongoing care reviews.
- SPICT™ Care Planning: this box highlights 6 key aspects of care planning that are very important for people whose health is deteriorating.
- SPICT™ is not designed to be a ‘prognostic’ tool. When a person will deteriorate further and die is uncertain. It is important to offer timely assessment and care planning to everyone at risk of deteriorating.
- In some countries, access to palliative care and support (including financial benefits) depends on assessment of life expectancy. Cohort research studies based on 2 or more SPICT general indicators give population risks of dying within 12 months, (See Resources: publications)
Why using the SPICT™ to identify people for assessment and care planning helps patients, families, professionals and teams
- Offers people opportunities to talk about their health declining and ‘what matters’ to them including things they hope to do or would like to happen.
- Gives priority to maintaining a person’s quality of life, and involving the people who are close to them
- Ensures that disease-modifying treatments of benefit are combined with good symptom control and other aspects of palliative care
- Reduces the risk of having to make complex treatment and care decisions in a ‘crisis’
- Encourages people to appoint a proxy decision-maker (Power of Attorney) and/or make ‘advance decisions’ about any treatments they would not want in the future
- Improves communication, continuity of care, current and future care planning; and multi-disciplinary team work
- Includes family members and other carers so they receive the help and support they need.
What about the ‘Surprise question’ (SQ)?There are several versions of the SQ but they often include a time frame unlike the original version described by Dr Joanne Lynn which looked at burden of illness.
- Some people use the SQ as a way of screening people for palliative care. The SPICT team think it is important to avoid ‘prognostic paralysis’ which can delay appropriate assessment and care planning so the SQ is not part of SPICT™. We accept the inherent uncertainty of living and dying with advanced progressive conditions and talk with people about thinking ahead, including being well prepared for future decision-making.
We ask the question: ‘Are there clinical indicators that the health of this person who has one or more progressive conditions is deteriorating?‘ If =YES, then it is time to assess the person’s holistic care needs and start planning future care with them.
Some ways of opening up a discussion about deteriorating health
- What do you know about your health problems and what do you think might happen in future?
- If you did get more unwell, what would be the most important things for you and your family?
- Is there anything that is particularly important for you or your family that we should know about?
- Sometimes people choose some family members or close friends to make decisions for them if they get less well……Is that something you’ve thought about? Have you talked to your family/ friends about it?
- I am glad you feel better and I hope you will stay well, but I am worried about what might happen if …………
- Can we talk about how we might cope with not knowing exactly what will happen and when? What would be the best way for us to talk about that?
- I wish we had more treatment for…..could we talk about what we can do if that is not possible/ is not going to help you?