SPICT-LIS™ helps identify people in low-income settings with advanced, progressive illnesses.
Offer the best available appropriate treatment. Assess unmet palliative care needs. Plan care.

Look for general indicators of poor or deteriorating health. May have one or more of these indicators.

Performance status is poor or deteriorating. (e.g., person stays in bed or a chair for more than half the day.)

Depends on others for care needs due to increasing physical and/or mental health problems.
Person's carer needs more help and support.

Progressive weight loss; remains underweight; weight gain from persistent fluid retention.

Persistent symptoms despite the best available appropriate treatment; cannot access treatment due to costs or distance to travel.

Person wishes to focus on quality of life; chooses to reduce, stop or not have treatment; asks for palliative care.

Unplanned hospital admissions; increased visits to hospital, clinic or health facility with progressive illness or complications.

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


Progressive or metastatic cancer with symptoms and functional decline.

Too frail for cancer treatment.
Cancer treatment is for symptom control only or is not available.

Dementia and frailty

Unable to dress, walk or eat without help.

Eating and drinking less; swallowing difficulties.

Urinary or faecal incontinence.

Little social interaction or communication.

Frequent falls; fractured femur.

Recurrent infections; aspiration pneumonia.

Neurological disease and stroke

Progressive deterioration in physical and/or cognitive function despite available therapy.

Increasing difficulty speaking and/or progressive swallowing difficulties.

Episodes of aspiration pneumonia; breathless or respiratory failure.

Ongoing severe disability after stroke despite best available rehabilitation.

Heart/vascular disease

Heart failure or extensive, untreatable coronary artery disease; breathlessness or chest pain at rest or on minimal effort.

Severe, inoperable peripheral vascular disease.

Respiratory disease

Severe chronic lung disease; breathlessness or chest pain at rest or on minimal effort.

Persistent hypoxia needing long term oxygen, if available.

Severe respiratory failure during exacerbations.

Kidney disease

Stage 4 or 5 chronic kidney disease with deteriorating health.

Kidney failure complicating other life-limiting conditions or treatments.

Stopping or not starting dialysis.

Liver disease

Cirrhosis with one or more complications in the past year:
  • diuretic resistant ascites
  • hepatic encephalopathy
  • hepatorenal syndrome
  • bacterial peritonitis
  • variceal bleeds


Advanced TB: deteriorating health despite best available TB drug regimen.

HIV: deteriorating health or complications not responding to best available treatment.

Other infections not responding to best available treatment and health deteriorating.

Surgical conditions and trauma

Severe burns with predicted poor outcome.

Serious condition with no access to surgery; condition or health too poor for surgery.

Brain injury with clinical deterioration and no benefit from surgical intervention.

Other conditions

Deteriorating with other illnesses and/ or complications that are not reversible (e.g. diabetes, haematological disease).

Deteriorating with multiple conditions or general frailty in older age despite best available treatment.

Review current care and care planning.

Review current treatment and medication; continue making sure person receives the best available appropriate treatment; minimise polypharmacy.

Consider referral for specialist palliative care review (if available) and/or other relevant specialist services when problems are complex and difficult to manage.

Agree a current and future care plan with the person and their family. Support family carers.

Plan ahead early if loss of decision-making capacity is likely.

Record, share, and review care plans regularly.


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