title: Development and evaluation of the Supportive and Palliative Care Indicators Tool (SPICT): a mixed-methods study.
abstract: OBJECTIVE
  To refine and evaluate a practical, clinical tool to help multidisciplinary teams in the UK and internationally, to identify patients at risk of deteriorating and dying in all care settings.
  
  
  METHODS
  We used a participatory research approach to refine the 2010 Supportive and Palliative Care Indicators Tool (SPICT) and evaluate its use in clinical practice. We conducted an ongoing peer review process for 18 months via an open access webpage, and engaged over 30 clinicians from the UK and internationally in developing an effective tool. Secondly, we carried out a prospective case-finding study in an acute hospital in SE Scotland. Four multidisciplinary teams identified 130 patients with advanced kidney, liver, cardiac or lung disease following an unplanned hospital admission.
  
  
  RESULTS
  The SPICT was refined and updated to consist of readily identifiable, general indicators relevant to patients with any advanced illness, and disease-specific indicators for common advanced conditions. Hospital clinicians used the SPICT to identify patients at risk of deteriorating and dying. Patients who died had significantly more unplanned admissions, persistent symptoms and increased care needs. By 12 months, 62 (48%) of the identified patients had died. 69% of them died in hospital, having spent 22% of their last 6 months there.
  
  
  CONCLUSIONS
  The SPICT can support clinical judgment by multidisciplinary teams when identifying patients at risk of deteriorating and dying. It helped identify patients with multiple unmet needs who would benefit from earlier, holistic needs assessment, a review of care goals, and anticipatory care planning.
authors.affiliation: Palliative Care Service, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Gill
authors.initials: G
authors.lastname: Highet
authors.affiliation: Palliative Care Service, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Debbie
authors.initials: D
authors.lastname: Crawford
authors.affiliation: Primary Palliative Care Research Group, Centre for Population Health Sciences, University of Edinburgh, Medical School, Edinburgh, UK.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Murray
authors.affiliation: Palliative Care Service, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Kirsty
authors.initials: K
authors.lastname: Boyd
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008875:Middle Aged; D020380:Needs Assessment; D010166:Palliative Care; D018579:Patient Selection; D011446:Prospective Studies; D012307:Risk Factors; D013727:Terminal Care
keywords: Chronic conditions; Clinical decisions; Prognosis; Programme development; Supportive care; Tool use behaviour