Supportive and Palliative Care Indicators Tool (SPICT™)

The SPICT™ is used to help identify people whose health is deteriorating.
Assess for unmet supportive and palliative care needs. Plan care.

Look for any general indicators of poor or deteriorating health.

Unplanned hospital admission(s).

Performance status is poor or deteriorating, with limited reversibility. (Person stays in bed or in a chair for more than half the day.)

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

Progressive weight loss; remains underweight; low muscle mass.

Persistent symptoms despite optimal treatment of underlying condition(s).

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.


Too frail for cancer treatment or treatment is for symptom control.

Functional ability is deteriorating due to progressive cancer.

Dementia/ frailty

Unable to dress, walk or eat without help.

Eating and drinking less; difficulty with swallowing.

Urinary and faecal incontinence.

Not able to communicate by speaking; little social interaction.

Frequent falls; fractured femur.

Recurrent febrile episodes or infections; aspiration pneumonia.

Neurological disease

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

Speech problems with increasing difficulty communicating and/or progressive difficulty with swallowing.

Recurrent aspiration pneumonia; breathless or respiratory failure.

Persistent paralysis after stroke with significant loss of function and ongoing disability.

Heart / vascular disease

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

Severe, inoperable peripheral vascular disease.

Respiratory disease

Severe, chronic lung disease; with breathlessness at rest or on minimal effort between exacerbations.

Persistent hypoxia needing long term oxygen therapy.​

Has needed ventilation for respiratory failure or ventilation is contraindicated.​

Kidney disease

Stage 4 or 5 chronic kidney disease (eGFR < 30ml/min) 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
  • recurrent variceal bleeds

Liver transplant is not possible.

Other conditions

Deteriorating with other conditions, multiple conditions and/or complications that are not reversible; best available treatment has a poor outcome.

Review current care and care planning.

Review current treatment and medication to make sure the person receives optimal care; minimise polypharmacy.

Consider referral for specialist assessment if symptoms or problems are complex and difficult to manage.

Agree a current and future care plan with the person and their family/people close to them. Support carers.

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

Record, share, and review care plans.


SPICT™ 2022