Use SPICT to identify individuals moving towards the end of life

SPICT

SPICT TM (Supportive & Palliative Care Indicators Tool) can help doctors identify people with life-limiting illnesses and/or deteriorating health. This is a suggestion for GPs who want to ensure their practice palliative care register is as comprehensive as possible. 

A GP with 2000 patients should expect, each year, 7-8 deaths from dementia/frailty, 6 from organ failure (eg COPD, heart failure) and 5 from cancer. Does the practice palliative care register reflect this?

If a practice doesn’t already have 1% of its practice list on the palliative care register and/or are trying to identify people at risk of acute deteriorations and hospital admission, SPICT TM can help.

SPICT TM is designed to recognise key points in the clinical trajectory of individuals with chronic and terminal diseases.

SPICT TM is not about identifying patients for specialist palliative care referral. It can’t predict when someone is going to die. But it can help identify people with life-limiting illnesses and/or deteriorating health. GPs can then plan care as soon as that might be of benefit, rather than only in the last few weeks or days. This may well include adopting a palliative care approach.

The SPICT team accepts “the inherent uncertainty of living and dying with advanced progressive conditions”. They want to promote conversations with people about thinking ahead, including being well prepared for future decision-making. They think it is important to avoid “prognostic paralysis”, since this can delay appropriate early palliative care.

This means that the ‘Surprise Question‘ is not part of SPICT ™.

Instead the SPICT team recommends looking for two or more general indicators of deteriorating health, and then moving on to look for some specific clinical indicators. If an individual is ‘SPICT TM positive’, it is time to assess the person’s holistic care needs and start planning future care with them.

SPICT TM is already being used by a number of primary care-based organisations in the UK

There is a free copy of the SPICT TM and the guides to using it here.

A practice computer audit would identify many of the indicators, as described here. Or perhaps the CCG/STP could do some of the computer work?

The SPICT TM list needs to be kept up to date at practice level, including when:

  • preparing any over 75 or individual care plans;
  • reviewing hospital letters;
  • reviewing any out-of-hours contacts;
  • referring patients for district nurse or social services input;
  • at medication review, when noticing poorly controlled symptoms;
  • reviewing / admitting people to nursing or residential homes.

When an individual is identified as at risk with SPICT TM, they can be offered future care planning. SPICT TM has some useful prompts and tips for starting conversations with people about deteriorating health.

 

Other references:

This blog post draws on part of an article I wrote for Pulse in Feb 2016.

Recognising and managing key transitions in end of life care BMJ 2010;341:c4863

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