The Supportive and Palliative Care Indicators Tool (SPICT) is widely used to identify individuals with palliative care needs. This article explores how SPICT facilitates advance care planning conversations, its usage across various patient cohorts and countries, the languages in which it has been validated, and its impact on documented goals of care.
How SPICT Aids Advance Care Planning
SPICT provides a structured framework for initiating and conducting end-of-life conversations. It offers a standardized language for multidisciplinary teams, ensuring clarity and consistency in care planning. Studies show that SPICT empowers clinicians to discuss essential aspects of end-of-life care, leading to increased palliative care planning. For instance, a German study found that general practitioners (GPs) trained in SPICT initiated actions like reviewing medications, minimizing polypharmacy, and planning for potential loss of decision-making capacity. Another study revealed that SPICT supported communication and care coordination, particularly for patients with non-cancer diagnoses.
Furthermore, SPICT enhances nurses’ self-efficacy in identifying patients nearing the end of life and prompting advance care plan discussions. In a renal ward study, nurses using SPICT identified 16% of newly admitted patients as needing palliative care, resulting in consultations and advance care directives for all identified patients. Similar success was observed in a cardiopulmonary unit, where SPICT screening led to a significant increase in palliative care referrals. Even in translation and validation studies, healthcare professionals reported that SPICT provided a common language for collaboration and enhanced their focus on patient needs.
SPICT Usage: Cohorts, Contexts, and Countries
SPICT’s application spans diverse patient populations, healthcare settings, and geographical locations. It has been utilized to screen for palliative care needs in individuals over 65, those with advanced cancer, and chronic diseases like cardiovascular, renal, and pulmonary diseases. SPICT has been employed in primary care, outpatient clinics, residential aged care, and even community households.
While originally developed for hospital settings, SPICT has found broader application in various contexts globally. Studies utilizing SPICT have been conducted across Europe, Asia, the USA, Australia, South Africa, Chile, and Peru. Notably, the UK was the first European country to incorporate SPICT into clinical guidelines for identifying palliative care needs.
Validated Languages for SPICT
SPICT has undergone rigorous translation, cross-cultural adaptation, and validation processes in multiple languages. The TRAPD model ensured the validity of Danish and German versions. The Beaton protocol was used for Italian, Spanish, Swedish, and Japanese translations. Further adaptations and validations have been conducted for Indonesian, Thai (SPICT-LIS for low-income settings), and a version specifically for the South African context (SPICT-SA). A simplified version, SPICT4-ALL, is available in English, German, Danish, and Spanish for use by families, friends, and care staff.
SPICT’s Influence on Documented Goals of Care
Evidence suggests that SPICT’s facilitation of end-of-life discussions leads to tangible changes in documented goals of care. A German study demonstrated improvements in documentation of care planning, preferred place of death, patients’ wishes, and spiritual beliefs following SPICT implementation. Another study in an Australian aged care facility revealed high rates of GP management plans and advance care directives among SPICT-identified residents. These findings underscore SPICT’s significant role in promoting comprehensive and patient-centered end-of-life care.
Conclusion
The Supportive and Palliative Care Indicators Tool (SPICT) is a valuable resource for identifying and addressing palliative care needs. Its structured framework, widespread usage, and availability in numerous languages make it a crucial tool for improving end-of-life care globally. SPICT empowers clinicians, enhances communication, and ultimately facilitates better outcomes for individuals facing life-limiting illnesses.
