For more information on SPICT-TW™, contact: Dr Ping-Jen Chen 陳炳仁醫師, email: [email protected]
支持性及緩和療護指標工具 – 2022台灣版 (SPICT-TW™)是由HOme-based Longitudinal Investigation of the MultidiSciplinary Team Integrated Care (HOLISTIC)研究團隊與台灣全國各地在社區從事基層健康照護的團隊共同發展，並驗證其信效度。HOLISTIC研究計畫是由國家衛生研究院群體健康研究所、台灣在宅醫療學會共同執行，由前所長熊昭教授、高醫大陳炳仁醫師、都蘭診所余尚儒醫師一起帶領團隊完成研究。
台灣社會的老化速度在世界上名列前茅，65歲以上人口占全人口從14%到21%預計只花10年的時間，將在2026年邁入超高齡社會，銀髮海嘯將對健康照護體系造成重大衝擊，如何建構以人為本、以照護需求為導向、以社區為基礎的連續性整合照護體系，是國家的重要議題。
台灣從1995年開辦全民健康保險，由國家擔任單一保險人打造幾乎全民納保的健康照護制度，自1996年起全民健保便給付安寧居家療護，2000年之後陸續將安寧病房、住院安寧共同照護納入健保給付，更重要的是在2009年，將健保安寧療護擴大到非癌症病人，包括失智、中風、各項器官衰竭等疾病。在2022年，健保安寧療護服務更進一步納入了末期衰弱老人，以及病人自主權利法中的對象，包括永久植物人、不可逆轉之昏迷、諸多神經退化性疾病，及罕見疾病等。在邁向去疾病化、非限定在生命末期、以及無圍牆的安寧緩和醫療的方向上，SPICT-TW是一個讓醫療團隊、甚至是病人與照顧者方便使用的實用工具。
SPICT-TW 並不只是一個用來評估何時啟動專科安寧療護的工具，也不是設計來做存活預估、或替代安寧療護啟動常用的”驚訝問題”的量表。SPICT-TW使用的核心目標是在一個人整體健康狀況有變動、出現健康惡化加速的風險，或是照護與支持的需求增加時，幫助及時辨識並評估緩和療護的需求，並方便討論合適的照顧計畫，並協調溝通有需要執行該照護計畫的相關人員，無論是社區或醫院中跨領域不同專業程度的醫療或照護工作者。
This SPICT tool is free to download. SPICT must not be reproduced in any other format nor modified in any way without permission.
All users are responsible for ensuring that they use the current version of this SPICT tool and for any use they make of SPICT and SPICT resources.
Please register for SPICT news and updates
This is important so that all SPICT users are aware of any changes or important information from the SPICT programme.
The SPICT-TW (Taiwan) has been developed and validated by the HOme-based Longitudinal Investigation of the MultidiSciplinary Team Integrated Care (HOLISTIC) investigators in collaboration with nationwide Taiwanese colleagues working for primary care in the community. The HOLISTIC study was funded and conducted by National Health Research Institutes, Taiwan and the Taiwan Society of Home Health Care, with the leadership by Professor Chao A. Hsiung, Dr. Ping-Jen Chen, and Dr. Sang-Ju Yu.
The speed of population aging in Taiwan ranks among the highest in the world. The ratio of older people aged 65 and above is expected to increase from 14% to 21% within just ten years, and by 2026, Taiwan will become a ‘Super-Aged Society.’ The Silver Tsunami will have a significant impact on the healthcare system. A critical national issue is constructing a person-centred, care needs-driven, and community-based integrated care system.
Taiwan launched its National Health Insurance (NHI) program in 1995, a universal single-payer health service scheme that covers more than 99% of legal residents. Since 1996, the NHI has reimbursed home-based palliative care, gradually expanding to include palliative care units and inpatient palliative liaison care after 2000. More importantly, in 2009, NHI extended palliative care services to non-cancer patients, including those with dementia, strokes, various organ failures, etc.
In 2022, NHI’s palliative care services were expanded to older people with severe frailty and individuals with disease categories specified in the 2016 Patient’s Right to Autonomy Act, including permanent vegetative status, irreversible coma, various neurodegenerative diseases, rare diseases, and more. As we move towards a paradigm of palliative care that focuses not only on end-of-life periods or limited diseases but also on offering care without the wall, SPICT-TW serves as a practical tool for healthcare teams, as well as patients and caregivers.
SPICT-TW is not just a tool for assessing when to initiate specialised palliative care, nor is it designed for survival prognosis or as a substitute for the commonly used ‘surprise question’ in palliative care initiation. The core objective of SPICT-TW is to facilitate the timely identification and assessment of palliative care needs when there are changes in a person’s overall health status, an increased risk of health deterioration, or a growing need for care and support. It aims to enhance discussions about appropriate care plans and coordinate communication among relevant persons involved in the care provision, whether health or social care professionals with varying expertise in palliative care, and whether in the community or a hospital.