Why use SPICT™?
SPICT™ is a clinical tool used by health and care staff in the UK and around the world. SPICT™ helps identify people with general indicators of poor or declining health and clinical signs of serious illnesses or health conditions. SPICT™ helps us look for changes in health and wellbeing, increasing burden of illness, and more care and support needs.
Many people are still identified too late. This happens more often if they have worsening organ function, multiple health conditions (multimorbidity) or increasing frailty in older age. People with a single or main serious illness may get care that is too disease-focused.
Identifying people earlier lets us find out what matters to them and offer a whole person review to look at symptom management, mental health problems, family, social and spiritual aspects of life. If we do this, more people of all ages, their families and carers can get the help and support they need to live well with changing health until they are dying.
When someone is dying, goals of care are different and care around dying continues into bereavement.
Future care planning to help people manage changes in life, heath and care is part of good palliative care.
SPICT™ is available in many languages, and as e-SPICT™.
SPICT-LIS™ is adapted for lower-income countries/settings.
SPICT-4ALL™ is our version in plain language suitable for care workers, patients and families.
SPICT-4ALL™ in Prisons is designed to improve palliative care for people in prison.
SPICT™ is designed for adults but we are keen to develop one for children. If you are interested in doing this work, please contact us.
Ways to use SPICT™
See: Using SPICT™ guide on this page)
- SPICT™ gives general indicators of deteriorating health and increasing care needs.
Does this person have one or more general indicators of poorer health?
(They may have had a key event like an emergency hospital visit or admission, or have moved into a care home/ elder care facility because of poorer health.) - SPICT™ has short descriptions of clinical indicators of serious illnesses and health conditions.
Does this person have one or more serious illnesses or health conditions not improving with the best available treatments?
Use these clinical indicators to help decide if this person (and their family and carers) should be offered a palliative care review and discussion about what matters to them in their life, health and care.
SPICT™ also offers a short guide to palliative care and future care planning actions. Wider aspects of holistic care are also important to address.
Use the REDMAP framework and resources to guide conversations about care planning.
Other tools used with SPICT™
- Changes in functional abilities or performance status
(e.g. Australia-modified Karnofsky Performance Scale) [Reference]. - Stage of illness
(e.g. Palliative Care Phase Tool) [Palliative Care Outcomes Collaboration] - Patient-reported outcome measures of multidimensional needs (e.g. IPOS)
SPICT™ and life expectancy
Life expectancy or prognosis for an individual is variable and uncertain. It is much better to recognise when a holistic palliative care review can help than trying to estimate how long this person will live.
If access to palliative care or financial benefits depends on making an estimate of life expectancy, then SPICT may aid clinical assessments but it is not designed as 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 serious health condition gives a population risk of dying within 12 months that has reasonable sensitivity and specificity. However, these estimates apply to populations of people not individuals.
(Surprise Question (SQ): this tool is no longer recommended for use on its own to identify people for palliative care and care planning.)
Key steps in future care planning
Healthcare Improvement Scotland (ihub) – future care planning
Preparation & planning
(Identify who needs care planning – prepare ourselves as health and care staff, and make sure the person and those close to them are ready too.)Meaningful conversations
(Use REDMAP. Find out ‘what matters’ and ‘who matters’ to the person and people close to them.)Documentation & sharing
(Record and share care plans so everyone knows what to think about if the person’s health and/or situation change.)Regular review
(Care plans are updated as the person’s situation or preferences change.)
Used with permission from Healthcare Improvement Scotland, Improvement Hub.
Future Care Planning Toolkit, 2023
Benefits of using SPICT™
- Offers people opportunities to talk about their health declining and ‘what matters’ to them including things they hope to do, would like to happen, or wish to avoid.
- Gives priority to maintaining a person’s quality of life, and involving the people who are close to them.
- Ensures that any available disease-modifying treatments of benefit are combined with good symptom control and other aspects of palliative care.
- Reduces the risk of complex treatment and care decisions in a ‘crisis’ by making emergency care plans for acute illness or complications (including for family caregiver changes).
- Encourages people to appoint a proxy decision-maker (Power of Attorney) and/or make ‘advance decisions’ about any treatments they do not want in the future.
- Improves communication, continuity of care, current and future care planning; and multi-disciplinary team work.
- Includes family members and other carers so they receive the help and support they need.