‘Supportive and Palliative Care Indicators Tool (SPICT) improves renal nurses’ confidence in recognising patients approaching end of life’

Abstract

BackgroundIdentification of people with deteriorating health is essential for quality patient-centred care and optimal management. The Supportive and Palliative Care Indicators Tool (SPICT) is a guide to identifying people with deteriorating health for care planning without incorporating a prognostic time frame.ObjectivesTo improve renal nursing staff confidence in identifying patients approaching end-of-life and advocate for appropriate multidisciplinary care planning.DesignThis pilot feasibility prospective cohort study conducted in the renal ward of a major metropolitan health service during 2019 included a preintervention/postintervention survey questionnaire. A programme of education was implemented training staff to recognise end-of-life and facilitate appropriate care planning.ResultsSeveral domains in the postintervention survey demonstrated a statistically significant improvement in renal nurses’ perception of confidence in their ability to recognise end of life. Of the 210 patients admitted during the study period, 16% were recognised as SPICT positive triggering renal physicians to initiate discussions about end-of-life care planning with patients and their families and to document a plan. Six months poststudy, 72% of those patients recognised as SPICT positive had died with a documented plan of care in place.ConclusionThe use of SPICT for hospital admissions and the application of education in topics related to end-of-life care resulted in a significant improvement in nurses’ confidence in recognising deteriorating and frail patients approaching their end of life. The use of this tool also increased the number of deteriorating patients approaching end of life with goals of care documented.

Use of the supportive and palliative care indicators tool (SPICT™) for end-of-life discussions: a scoping review

“…In addition, three studies found that nurses who were trained to use the SPICT™ increased their self-efficacy in identifying patients who may be nearing the end of life and promoted an advance care plan discussion with these patients 28 29 34 . 21−23 In the study set in a renal ward, patients were screened on admission to identify those nearing the end of life by nurses using the SPICT™ [ 34 ]. An alert was added to the ward patient name list when a patient was identified as nearing the end of life (‘SPICT™ positive’) which prompted a review by the physician and multidisciplinary team.…”

“…An alert was added to the ward patient name list when a patient was identified as nearing the end of life (‘SPICT™ positive’) which prompted a review by the physician and multidisciplinary team. In this study 16% (25/152) of newly admitted patients were screened as ‘SPICT™ positive’; all of these patients received a palliative care consult and were discharged with an advance care directive including a resuscitation plan [ 34 ]. Incidentally nurses reported a significant increase in their ability to identify patients approaching end of life.…”

No Terminally Ill Patients with Non-cancer Received Palliative Care Services During Hospital Admission: A Cross-Sectional Study

“…7 These patients had heart/vascular disease, dementia/frailty, and respiratory disease. Renal nurses educated in the use the SPICT identified that 16% of the patients with renal disease required PC 8 Of these patients, 72% died within six months of the study, and these patients had an advance directive. A community-based study in India reported that the SPICT showed that 4.31% of the general population and 20% of individuals with chronic conditions required PC 9 The most common chronic conditions were heart disease (37.5%), dementia/frailty (29.5%), and respiratory diseases (19.3%).…”

“…A community-based study in India reported that the SPICT showed that 4.31% of the general population and 20% of individuals with chronic conditions required PC 9 The most common chronic conditions were heart disease (37.5%), dementia/frailty (29.5%), and respiratory diseases (19.3%). Patients with chronic conditions such as liver disease, 10 heart disease, 11 COPD, 12 and renal disease, 8 can benefit from the SPICT because they can then access PC services from health care providers.…”

Supportive and palliative care indicators tool (SPICT™) in a Danish healthcare context: translation, cross-cultural adaptation, and content validation

“…For example, studies show that the tool can be useful as a support in clinical decision-making in hospitals to identify patients in need of palliative care [16] and can be used to identify older hospitalized patients at risk of dying within a year [23]. Furthermore, a study by Lunardi et al 2020 showed [24] that the use of SPICT ™ gave a significant improvement in the nurses' confidence and abilities to recognize patients approaching their end of life.…”