Supportive and Palliative Care Indicators Tool

The SPICT™ helps us to look for people who are less well with one or more health problems. These people need more help and care now, and a plan for care in the future. Ask these questions:

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

Unplanned (emergency) admission(s) to hospital.

General health is poor or getting worse; the person never quite recovers from being more unwell. (This means the person is less able to manage day to day life, and often stays in bed or in a chair for more than half the day).

Needs help from others for care 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.

Look for clinical indicators of one or multiple life-limiting conditions.


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/ 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

(eg Parkinson’s, MS, 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.

Severe stroke with loss of movement and ongoing disability.

Heart or circulation problems

Heart failure or has bad attacks of chest pain. Short of breath when resting, moving or walking a few steps.

Very poor circulation in the legs; surgery is not possible.

Lung problems

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 the hospital.

Kidney problems

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

Stopping kidney dialysis or choosing supportive 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 and may die from other health problems or complications. 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 about any help needed now and why making plans for care is important in case things change

Ask for help and advice from a nurse, doctor or other professional who can assess the person and their family and help plan care.

We can look at the person’s medicines and other treatments to make sure we are giving them the best care or get advice from a specialist if problems are complicated or hard to manage.

We need to plan early if the person might not be able to decide things in the future.

We make a record of the person's care plan and share it with people who need to see it. Plans can be changed at any time, if needed.


SPICT™ 2023