Developing the SPICT™

scotland flagThe SPICT™ is a clinical tool was first developed in 2010 as a collaborative project between NHS Lothian and The University of Edinburgh Primary Palliative Care Research Group.

The SPICT programme team is based in Edinburgh, Scotland. There are now many SPICT Partners across the UK and around the world who are all part of the international SPICT programme.

Supportive and Palliative Care Indicators Tool (SPICT):
  1. Simple, one page format.
  2. Readily identifiable general indicators of deteriorating health commonly present in advanced conditions.
  3. Evidence-based clinical indicators of all the major advanced, life-limiting conditions and multimorbidity.
  4. Good face validity for health & social care professionals working in hospital, community and care home settings in the UK and internationally.
  5. Promotes early supportive and palliative care in parallel with optimal management of any underlying conditions as part of routine clinical practice.
  6. Contains accessible language and concepts that can be used to initiate discussions with patients and families about goals of care and improve communication between professionals/ teams.


SPICT ScreenshotBackground

  • Systematic identification of patients with advanced conditions who are at risk of deteriorating and dying is a prerequisite for effective supportive and palliative care in the final months to years of life.
  • Interventions to improve the current and future care of these people and their families depend on better and earlier identification.
  • Clinical judgement about whether a patient is at risk of deteriorating and dying is based on multiple sources of evidence. No tool predicts prognosis accurately for an individual patient.

“The physician’s goal is to formulate an individualised prognosis for the patient starting with a generalised prognosis and modifying it using clinical observations, performance status, symptoms, co-morbidities, will-to-live and knowledge of illness trajectories.”

– Glare P. Journal of Palliative Medicine 2008:11(1):84-103.


SPICT™ was developed using three integrated, participatory approaches:
Literature review of consensus documents, research studies, policy documents and published tools such as GSF, NECPAL and RADPAC (see Other resources) describing clinical indicators of advanced illness or a limited prognosis in diverse advanced illnesses and multimorbidity.

Peer review via our open access SPICT website and ongoing collaboration with SPICT partners in the UK and around the world.

Prospective, case finding study in an acute hospital setting in SE Scotland


  • Boyd K, Murray SA. Recognising and managing key transitions in end of life care. BMJ 2010; 341:c4863
  • 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. A copy for personal use can be downloaded: Download SPICTpaper


  • The SPICT™ can aid clinical decision-making by multidisciplinary teams caring for patients with advanced conditions who are at risk of deteriorating and dying so are likely to benefit from holistic needs assessment and care planning.
  • The SPICT™ can prompt assessment of patients for unmet holistic supportive & palliative care needs, and help initiate a review of people’s priorities, options for treatment and care and care planning
  • Some professionals and teams still use the “Surprise Question” in combination with the SPICT. We suggest using SPICT to ask: Is this person’s health deteriorating due to one or more advanced conditions such that they would benefit from holistic needs assessment and care planning?
  • The SPICT™ is not designed to identify patients for specialist palliative care referral, but primarily to support improved care by those providing general supportive and palliative care for their patients.