Supportive and Palliative Care Indicators Tool
(SPICT-4ALL™)

The SPICT™ helps us look for people who have life shortening health conditions and are less well. These people need more help and care now, and a plan for care in the future.

Does this person have signs of poor health or health problems that are getting worse?

Urgent or emergency hospital admission(s) or visits.

Less able to manage usual activities; not as well as they used to be. (The person often stays in bed or in a chair for more than half the day.)

Needs more help and care from others due to increasing physical and/ or mental health problems. The person’s carer needs more help and support.

Has clearly lost weight over the last few months; or stays too thin.

Has troublesome symptoms most of the time despite good treatment of their health problems.

The person (or family) asks for palliative care; chooses to reduce, stop or not have treatment; or wishes to focus on quality of life.

Does this person have any of these health problems?

Cancer

Less able to manage usual activities and health is getting poorer.

Not well enough for cancer treatment or treatment is to help with symptoms.

Dementia or frailty

Unable to dress, walk or eat without help.

Eating and drinking less; difficulty with swallowing.

Has poor control of bladder and bowels.

Not able to communicate by speaking; not responding much to other people.

Frequent falls; fractured hip.

Frequent infections; pneumonia

Nervous system problems

(e.g., Parkinson's disease, stroke, motor neurone disease)

Physical and mental health are getting worse.

More problems with speaking and communicating; swallowing is getting worse.

Chest infections or pneumonia; breathing problems.

Ongoing disability with increasing physical and/or mental health problems after one or more strokes.

Heart or circulation problems

Heart failure or heart blood vessel disease. Short of breath or has chest pain when resting, moving or walking a few steps.

Leg problems due to poor blood circulation; surgery is not possible.

Lung problems

More unwell with long term lung problems. Short of breath when resting, moving or walking a few steps even when the chest is at its best.

Needs to use oxygen for much of the day and night.

Has needed treatment with a breathing machine in hospital.

Kidney problems

Kidneys are not working well; general health is getting poorer.

Stopping kidney dialysis or choosing palliative care instead of starting dialysis.

Liver problems

Worsening liver problems in the past year with complications like:
  • fluid building up in the belly
  • being confused at times
  • kidneys not working well
  • infections
  • bleeding from the gullet

A liver transplant is not possible.

Other conditions

People who are less well with other life shortening physical or mental illnesses or health conditions. There is no treatment available or it will not work well.

What we can do to help this person and their family.

Start talking with the person and their family or carer about help needed now and why making plans is important in case things change.

Ask for help and advice from a nurse, doctor, social worker or other staff if the person or family needs a review of their care and support.

We look at the person’s medicines and other treatments to give the best care. Holistic care includes symptoms, emotional, social, financial, or spiritual problems.

Ask for specialist help if symptoms or problems are difficult to manage.

Care plans are shared with staff who need to see them and kept up to date.

061223

SPICT™ 2025