Page 51 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 22 of 26 Guideline

Appendix 4: The Support and Palliative Care Indicator Tools (SPICT )
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The SPICT is a guide for identifying people at risk of deteriorating health and imminent death. This group of patients must be assessed for
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unmet supportive and palliative care needs.
1. Look for two or more general indicators of deteriorating health:
• Performance status is poor or worsening, that is, the person is in bed or in a chair for ≥ 50% of the day; reversibility is judged as limited
• Dependent on others for most care needs; dependency is because of physical and/or mental health problems
• Two or more unplanned hospital admissions in the past 6 months
• Significant weight loss (5% – 10%) over the past 3–6 months and/or a low BMI < 18 kg/m 2
• Persistent, troublesome symptoms despite optimal treatment of underlying conditions
• Patient asks for supportive and palliative care or for the withdrawal of treatment.

1. Look for any clinical indicators of one or more advanced conditions:
Cancer:
• Functional ability deteriorating because of progressive metastatic cancer
• Too frail for oncology treatment or treatment is for symptom control only.

Dementia/frailty:
• Unable to dress, walk or eat without help
• Eating and drinking less; swallowing difficulties
• Urinary and faecal incontinence
• No longer able to communicate using verbal language; minimal social interaction
• Fractured femur; multiple falls
• Recurrent febrile episodes or infections; aspiration pneumonia.

Neurological disease:
• Progressive deterioration in physical and/or cognitive function despite optimal therapy
• Speech problems with increasing difficulty communicating and/or progressive swallowing difficulties
• Recurrent aspiration pneumonia; breathless or respiratory failure.

Heart and/or vascular disease:
• New York Heart Association (NYHA) Class III/IV heart failure or extensive, untreatable coronary artery disease with:
ß Breathlessness or chest pain at rest or on minimal exertion
• Severe, inoperable peripheral vascular disease.

Respiratory disease:
• Severe chronic lung disease with:
• Breathlessness at rest or on minimal exertion between exacerbations
• Needs long-term oxygen therapy
• Has needed ventilation for respiratory failure or in whom ventilation is contraindicated.

Kidney disease:
• Stage 4 or 5 chronic kidney disease (viz. an eGFR < 30 mL/min), with deteriorating health
• Kidney failure complicating other life-limiting conditions or treatments
• Discontinuation of dialysis.

Liver disease:
• Advanced cirrhosis with one or more complications in the past year:
ß Diuretic-resistant ascites
ß Hepatic encephalopathy
ß Hepatorenal syndrome
ß Bacterial peritonitis
ß Recurrent variceal bleeds
• Liver transplantation is contraindicated.

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