The Supportive and Palliative Care Indicators Tool (SPICT™) has emerged as a crucial instrument in healthcare for identifying patients in need of palliative care. This review delves into the effectiveness, application, and global reach of the SPICT tool, drawing from a comprehensive analysis of 26 reports. Understanding how the Palliative Care Spict Tool aids in conversations about advance care planning and its widespread use across diverse settings and populations is paramount to improving end-of-life care.
SPICT™’s Role in Facilitating Advance Care Planning Conversations
Research indicates that the SPICT™ tool significantly assists clinicians in conducting sensitive conversations about advance care planning. It provides a structured approach, acting as a proforma that covers essential aspects of end-of-life care. This framework not only guides end-of-life discussions but also establishes a common language, fostering better collaboration within multidisciplinary healthcare teams.
A prospective feasibility study examining the practical application of the SPICT™ highlighted its effectiveness in boosting palliative care planning. General practitioners (GPs) who were trained in using the German version of the SPICT™ (SPICT-DE™) applied it to adult patients diagnosed with life-limiting diseases over a two-month period. The study revealed that the SPICT-DE™ prompted GPs to take appropriate actions, most frequently including agreeing on current and future care plans with patients and their families (75%), reviewing and optimizing current treatments and medications (67%), and proactively planning for potential loss of decision-making capacity (62%). Notably, referral for specialist palliative care consultation was considered necessary for 32% of patients. The impact of the SPICT™ was evident in the follow-up, with a significant number of GPs initiating actions such as medication review (46%) and advance care planning (37%).
Further research by Afshar et al. in Germany demonstrated that GPs found the SPICT™ beneficial in improving communication and care coordination. They observed that the tool broadened their understanding of patient needs, particularly for those with non-cancer diagnoses. Impressively, over half of the patients in this study had their agreed care plans initiated within six months of follow-up. While some experienced GPs felt the tool didn’t alter their practice, a substantial majority (over two-thirds) envisioned integrating the SPICT-DE™ into their routine practice.
Moreover, studies have shown that nurses trained in using the SPICT™ experienced increased confidence in identifying patients nearing the end of life. This enhanced self-efficacy encouraged them to initiate advance care planning discussions. In a renal ward setting, nurses used the SPICT™ to screen patients upon admission. Patients identified as ‘SPICT™ positive’ triggered an alert, prompting review by physicians and the multidisciplinary team. In this specific study, 16% of new admissions were screened as ‘SPICT™ positive,’ all of whom subsequently received a palliative care consultation and were discharged with advance care directives, including resuscitation plans. Importantly, nurses reported a significant improvement in their ability to recognize patients approaching end-of-life.
Similarly, a clinical improvement project in a long-term acute care facility’s cardiopulmonary unit, which focused on improving palliative care screening and consultation using the palliative care SPICT tool, revealed high screening rates and increased end-of-life conversations and referrals. Nurses trained in SPICT™ screened all new admissions, with a significant number identified as ‘SPICT™ positive’. Although initial palliative care consultation rates were lower, all consulted patients received resuscitation plans and advanced directives. The use of SPICT™ in screening led to a notable doubling of monthly palliative care referrals at the facility. Another project aimed at enhancing palliative care screening in ambulatory care settings found that nurse practitioners considered the SPICT™ invaluable, describing it as a tool that ‘opens the door to a discussion of palliation’ and is ‘helpful in determining eligibility for palliative care.’ This project demonstrated a substantial increase in palliative care referrals after SPICT™ implementation.
Studies translating and validating the SPICT-DK™ (Danish) and SPICT-SE™ (Swedish) also highlighted positive feedback from healthcare professionals. Doctors and nurses described the tool as providing a shared linguistic framework, enabling collaboration and focused patient care. Nurses and medical doctors emphasized the tool’s specificity in guiding palliative care decisions.
However, not all feedback was uniformly positive. An expert committee involved in translating and adapting the SPICT™ into Japanese expressed concerns about its suitability in a culture where ‘not-telling the truth’ is prevalent and healthcare is highly specialized, potentially fragmenting care planning. This highlights the importance of cultural context in the application of the palliative care SPICT tool.
Broad Scope of SPICT™ Usage Across Diverse Contexts
The SPICT™ tool has been utilized across a wide range of patient populations, healthcare settings, and countries to identify palliative care needs. These populations include older adults (over 65 years), individuals with advanced cancer, and those with chronic conditions such as cardiovascular, renal, and pulmonary diseases.
Ten studies included in this review were conducted in primary care and general practice settings, underscoring the tool’s relevance in community-based healthcare. The SPICT™ has also been implemented in outpatient clinics, residential aged care facilities, and even community households in rural India, demonstrating its adaptability to various care environments. Originally designed for hospital settings, though not formally validated there during its initial development, the SPICT™ has proven to be a versatile tool across the healthcare spectrum.
Geographically, the included studies reveal a global distribution of SPICT™ use. A significant number of studies were conducted in European countries, followed by Asia, the USA, Australia, South Africa, Chile, and Peru. A review based in Switzerland further contributes to the international perspective. Notably, a systematic review and survey of European primary care GP practices indicated that, at the time, the United Kingdom was unique in incorporating the SPICT™ into national clinical guidelines for identifying palliative care needs in both primary and secondary care.
SPICT™ Validation Across Languages
The palliative care SPICT tool has undergone rigorous translation, cross-cultural adaptation, and validation processes in multiple languages to ensure its global applicability. Validated versions are available in Danish and German, utilizing the TRAPD (Translation, Review, Adjudication, Pre-testing, and Documentation) model. Further validation of the SPICT-DE™ in German general practice has been established through patient cohort studies.
Additionally, the SPICT™ has been translated and adapted into Italian (SPICT-IT™), Spanish (SPICT-ES™), Swedish, and Japanese (SPICT-J™) using the Beaton protocol for cross-cultural adaptation of health measures. Studies have confirmed the reliability and validity of the SPICT-ES™ and SPICT-J™ in their respective cultural contexts. An Indonesian version has also been developed and shown to be highly reliable and effective in identifying unmet palliative care needs in hospital patients.
For low-resource settings, the SPICT™ for Low-Income Settings (SPICT-LIS™) was translated and adapted for use in Thailand, demonstrating high interrater reliability among nurses and GPs in assessing palliative care needs. A Delphi study informed the development of the SPICT™ for the South African context (SPICT-SA™), which includes adaptations for local disease profiles, although further validation is needed. Comparative research in the Netherlands (SPICT-NL™) indicates that the SPICT™ outperforms the Surprise Question (SQ) in identifying patients, particularly younger individuals, who would benefit from palliative care.
The SPICT4-ALL™ represents a simplified iteration of the original SPICT™, intended for use by family members, friends, and non-clinical care staff to recognize palliative care needs. Available in English, German, Danish, and Spanish from the SPICT™ website, it has been successfully used in community settings, although formal validation studies are still lacking.
SPICT™’s Impact on Documented Goals of Care
Evidence suggests that the SPICT™ tool, by facilitating end-of-life care discussions, contributes to tangible improvements in documented goals of care. A pre-post intervention study involving German GPs trained in palliative care and SPICT-DE™ usage demonstrated this impact. Alongside a public awareness campaign on end-of-life care, the study found significant improvements in GPs’ documentation practices after SPICT-DE™ implementation. Documentation of care planning increased from 33% to 51%, and documentation of preferred place of death rose from 20% to 33%. Similarly, recording of patients’ wishes and spiritual beliefs improved from 18% to 27%. Notably, GPs also reported an increase in their perceived quality of end-of-life care following the intervention.
In an Australian aged care facility study comparing SPICT™ and SQ, residents screened as SQ-positive and subsequently SPICT™-positive showed high rates of palliative care provision and advance care planning documentation. While it’s not definitively shown that SPICT™ directly caused changes in documentation in this SQ-SPICT comparison study, the high correlation between SPICT™ positivity and existing care plans suggests its role in reinforcing and identifying the need for such documentation.
In conclusion, the palliative care SPICT tool stands as a valuable asset in modern healthcare. Its ability to facilitate crucial conversations, its broad applicability across diverse settings and languages, and its positive impact on care planning documentation underscore its importance in enhancing the quality of end-of-life care globally. As healthcare systems worldwide continue to focus on patient-centered care, the SPICT™ tool offers a practical and validated method for ensuring that palliative care is integrated effectively and compassionately for those who need it most.
