Development and evaluation of the Supportive and Palliative Care Indicators Tool (SPICT): a mixed-methods study

Area of Science:

• Palliative Care
• Clinical Tools
• Patient Deterioration

Background:

• The 2010 Supportive and Palliative Care Indicators Tool (SPICT) required refinement for broader clinical application.
• Identifying patients at risk of deterioration and death is crucial across all care settings.

Purpose of the Study:

• To refine and evaluate a practical clinical tool, the SPICT, for identifying patients at risk of deteriorating and dying.
• To support multidisciplinary teams in the UK and internationally with patient risk identification.

Main Methods:

• A participatory research approach was used to refine the SPICT over 18 months with international clinician input.
• A prospective case-finding study was conducted in an acute hospital involving four multidisciplinary teams.
• 130 patients with advanced kidney, liver, cardiac, or lung disease were identified post-unplanned admission.

Main Results:

• The refined SPICT includes general and disease-specific indicators for advanced illnesses.
• Hospital clinicians successfully used the SPICT to identify at-risk patients.
• Patients who died had significantly more unplanned admissions, persistent symptoms, and increased care needs; 48% died within 12 months.

Conclusions:

• The SPICT effectively supports clinical judgment in identifying patients at risk of deterioration and death.
• The tool facilitates the identification of patients with unmet needs, enabling earlier holistic assessment and care planning.
• Early identification supports timely reviews of care goals and anticipatory care planning.