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Why use SPICT™?

SPICT™ is a widely used tool for health and care staff in the UK and around the world.  SPICT™ helps us identify people with general indicators of deteriorating health, and signs that one or more life shortening conditions are getting worse. SPICT™ helps us look for changes in a person’s health and wellbeing, increasing burden of illness, and more care and support needs. More people of all ages, their families and carers, can get help to live as well as possible until they are dying.

Many people are still identified too late. This happens more often if they have worsening organ function, 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, 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.

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?
  • Act: SPICT™ indicators can help you decide if this person (and their family and carers) should be offered a palliative care review and discussions about future care planning. You can also use them to ask for advice from a colleague.


SPICT™ has some tips on doing a palliative care review and starting future care planning – there is more information in the Using SPICT™guide.

View e-Using SPICT™ on your device
Download Using SPICT™ (pdf)

Other tools used with SPICT™


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. 

Research studies with groups of patients in different countries found that having at least two SPICT™ general indicators AND at least one life-shortening condition gives an overall population risk of dying within 12 months. However, these estimates are for populations of people and do not apply to individuals. 

(Surprise Question (SQ): this tool is no longer recommended for use on its own to identify people for palliative care and care planning.)