Using SPICT 2

Introducing SPICT™ (Supportive & Palliative Care Indicators Tool)

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

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 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 a complication of long term conditions.

What is the SPICT™ (Supportive & Palliative Care Indicators Tool)?

  • SPICT™ has 6 general indicators of deteriorating health and increasing needs that occur in many advanced illnesses. People identified for assessment usually have 2 or more general indicators.
  • The general indicators can be used alone to prompt an assessment or combined with looking for the evidence-based, indicators of individual advanced conditions.
  • SPICT™ helps professionals review their patients and make decisions about who to assess. SPICT™ does not give a ‘prognosis’ or indicate that the person will die within a specific time frame. How and when individual people deteriorate and die is too variable. It is important to offer timely assessment and care planning to everyone.

What about the ‘Surprise question’ (SQ)?

There are several versions of the SQ but they all include a time frame:
Would you be surprised if this person died in the next 6-12 months (or weeks to months or a year)?

  • Some people use this tool as a way of screening people for palliative care. The SPICT team think it is important to avoid ‘prognostic paralysis’ which can delay appropriate care. We accept the inherent uncertainty of advanced progressive illnesses and talk with people about managing it.

We prefer to answer the question:
Are there clinical indicators that this person who has one or more advanced conditions is deteriorating and at risk of dying?
If =YES, then assess their holistic care needs and start planning future care.

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
  • 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

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?

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