Using SPICT
Why use SPICT?
SPICT is widely used by health and care staff and workers in the UK and increasingly all around the world. SPICT helps us look for changes in a person’s health and wellbeing, increasing impact of health problems on their life, and more care and support needs. More people of all ages, their families and carers, need help to live as well as possible with life shortening conditions until they are dying.
People’s health often fluctuates and their life expectancy is uncertain. Many people are still identified too late. This happens more often if they have worsening organ function (heart, lung, liver or kidney conditions), neurological conditions including dementia, multiple health conditions (multimorbidity) or frailty in older age. People with a single or main life shortening condition are at risk of care that is more disease-focused than person-centred.
People who find it harder to get the health and care they need have similar problems when they need palliative care. This may be due to factors like poverty, where they live, personal characteristics, learning disabilities or mental illness, drug or alcohol use, communication or language barriers, culture, values and beliefs.
Identifying people earlier lets us ask about what matters to them and what can help. Palliative care can start with a holistic review that might include symptom management, medicines and treatments that help or could stop, mental health and wellbeing, family, social, functional, practical, and spiritual aspects of life.
When someone is dying with life shortening conditions or has a final illness and is in their last days of life, we focus on comfort and holistic care. Palliative care when someone is dying includes support for people close to the dying person that goes on into bereavement.
SPICT has been developed for adults. SPICT-child for babies, children and young people under 18 years is being developed. If you are interested, please contact us.
Future care planning to help people manage changes in their life, health and care is part of good palliative care. It includes families and carers. Future care planning can help people avoid crises and be better prepared if things do change for them.
Ways to use SPICT
- Think: Does this person have one or more general signs of poorer health and increasing health or care needs?
They may have had a key event like an emergency hospital visit or admission, or have moved into a care home/ elder care facility or need more care at home, or they may have worsening symptoms. - Check: Does this person have sign of one or more life shortening conditions that are not improving with the best available treatments?
Look for conditions that may be reversible so that palliative care is integrated with other treatment options, if appropriate. - Act: Does this person need an urgent or planned review and who is the best team member or colleague to offer it?
Use SPICT indicators to help you decide when and how to offer this person (and their family/carers) a palliative care focused review and/or discussions about future care planning. You can also the indicators to ask for advice from a colleague and/or open conversations with people and families.
SPICT has a short list of key actions in a palliative care review and future care planning. Start with what is most relevant to a person and family.
- Using SPICT has more information.
Other tools and resources used with SPICT
- Spectrum of Palliative Care poster (2025)
Graphics and text to help staff to provide early palliative care through to care around dying – at home, in care homes and in hospitals. - NHS inform – palliative care
Public information and downloadable resources - Scottish Palliative Care Guidelines
Evidence-based guidance for health professionals and social workers. - Having Realistic Conversations
Free resources for teaching health and care staff and workers about,
– Shared decision making [DECIDE]
– Future care planning [REDMAP] (includes advance care planning) - Palliative Care Learning Hub – Public Services Delivery Scotland
Free registration and access from Scotland’s TURAS learning platform
- Change in functional abilities or performance status
(e.g. Australia modified Karnofsky Performance Scale) - Stage of illness
(e.g. Palliative Care Phase Tool) - Patient-reported outcome measures (e.g. IPOS)
- Carer support
(e.g., Carer Support Needs Assessment Tool Intervention [staff] + Support Needs Approach for Patients -SNAP [people and families])
SPICT and life expectancy
Life expectancy or prognosis for an individual is variable and uncertain. It is much better to recognise when a timely, holistic palliative care review can help them.
If access to palliative care or financial benefits depends on an estimated life expectancy, then SPICT can help with making clinical assessments. SPICT is not a prognostic tool.