Use SPICT to identify individuals moving towards the end of life


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.

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Awareness and acceptance?

Awareness and acceptance are often trumpeted as the ‘right’ way to go for patients with a terminal diagnosis.

As a clinician, I certainly saw how people ‘in denial’ (or with their oncologists seemingly in denial!) often had ‘a bad death’, after the inevitable inevitably became clear.

So the idea of being fully aware and ‘accepting’ an impending death definitely seems — on the face of it — the best idea. It’s easy to think that patients and relatives are just foolish if they don’t join in ‘accepting’ what those clever doctors (haven’t quite) said.

I would like to raise some fundamental questions about awareness and acceptance.

After all, some — or maybe it’s many — doctors seem to have what might be described as almost an existential crisis when a patient doesn’t get better. Danielle Ofri has written explicitly about how doctors find it extremely difficult to simply tell the truth to patients, when it seems that curative treatment is unlikely to work. Maybe that is because doctors are trained to do things to make people better. It’s their raison d’etre!

Don’t patients have an even more existential task, when it comes to imagining their own death?

And it’s all very well for clinicians to ‘help’ patients and relatives with awareness and acceptance. When even (relatively time-rich) palliative care clinicians only spend maybe a few hours with each of their patients. After which the doctors can get on with their  own lives.

I’m not saying end of life care is easy for clinicians: the high numbers with burnout show the extent of the problem.

But awareness and acceptance is a 24/7 job for patients and relatives.

So no wonder some patients are into denial.

The most commonly advertised options are to ‘bravely fight’ (most commonly for other sorts of treatment) or indulge (surely we’re all worth it!) in distractional ‘bucket list’ activities.

See linked posts: Brendan McCann’s story about his partner not understanding he had cancer; and my exploration of collusion in doctor-patient communication.