Using SPICT 2

Introducing SPICT™

SPICT™ is used by health and care professionals to help them identify people at risk of deteriorating and dying with one or more advanced, progressive conditions or a new life-limiting illness.

Many of these people (particularly if they don’t have cancer) are identified too late to benefit from well-coordinated, supportive and 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 can then 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 more gradually as well as for people at risk of an acute illness (due to underlying frailty) or who are at risk of developing a complication of a long term condition.

Using SPICT™

Try looking at the people attending your clinic/ surgery or on your ward round; look at the people living in the care home you visit or living at home – use the SPICT™ indicators to help you decide if their health might be deteriorating.

Review 3-5 people you have identified using the SPICT™ general indicators and who have one or more advanced conditions – choose the people who are most unstable and at risk of deteriorating and start a conversation about planning care with them and their families.

Use the SPICT™  indicators as a ‘checklist’ to screen a population of people for further needs assessment.

Ask for a review of a person’s care and support needs by highlighting that they have SPICT™ indicators of deteriorating health and might benefit from care planning. Some people find SPICT-4ALL™ useful for this.

Use the SPICT™ or the SPICT-4ALLto help you open up a conversation with people about their health and care by referring to changes in an individual’s health shown by some of the SPICT indicators.

  • SPICT™ has 6 general indicators of deteriorating health and increasing needs that occur in many advanced illnesses. People identified with SPICT™ usually have 2 or more general indicators, but use your own judgement to decide if you think this person could benefit from  assessment and care planning even if they only have one of the general indicators.
  • The general indicators can be used alone to prompt an assessment or combined with looking for the evidence-based indicators of advanced conditions outlined in SPICT™.
  • SPICT™ helps professionals review their patients and make decisions about who to assess and how the person’s care might need to be reviewed and planned.
  • SPICT™ is not a structured needs assessment tool so you may want to combine it with the Palliative Care Phase scoring system or the IPOS to help you decide the urgency of patient reviews and to structure your assessment and care planning.
  • SPICT™ is not a ‘prognostic’ tool. When people are identified using SPICT™ that does not mean the person will die within a specific time frame. How and when individual people will deteriorate and die is highly variable. It is important to offer timely assessment and care planning to everyone at risk of deteriorating.

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 want 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 that are of benefit are combined with good symptom control.
  • Reduces the risk of having to make complex treatment and care decisions in a ‘crisis’
  • Encourages people to consider appointing 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, such as:
Would you be surprised if this person died in the next 6-12 months?

  • 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 early palliative care 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 this person who has one or more advanced conditions is now deteriorating and at risk of dying?
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 a family member or a close friend to make decisions for them if they get less well……Is that something you’ve thought about? Have you talked to your family 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?

Look for more ideas on our Resources page or on the EC4H website