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Developing the Supportive and Palliative Care Indicator Tool (SPICT) for resource poor settings

Author: Dan Munday, Daniel Munday, Consultant in Palliative Care and Health Services Research, Consultant Adviser to International Nepal Fellowship, Visiting Professor of Palliative Care, Nepali National Academy of Medical Sciences (NAMS), Adviser to Nepalese Association for Palliative Care (NAPCare)
18 August 2017

The SPICT international community of practice is inviting interested colleagues to join a working group to develop (SPICT-RSP.)

Integrated management of non-communicable disease (NCD) which includes palliative care, is an important aspect of Universal Health Coverage (UN Sustainable Development Goal - Target 3.8).

WHO has identified that effective NCD management in low and middle-income countries (LMICs)and other resource poor settings relies on well-developed primary care.

As NCD incidence increases in LMICs, it is essential that primary care clinicians in these settings can effectively identify and manage people needing palliative care.

SPICTTM is a tool for identifying patients with advanced cancer and other life limiting conditions who could benefit from a palliative care approach to their management. Its development has been led by clinicians and researchers in Edinburgh, Scotland, and has involved an international community of practice.

SPICTTM is a based on the following principles:

  1. A simple one page format.
  2. Readily identifiable general indicators of deteriorating health commonly present in advanced conditions are highlighted.
  3. Evidence-based clinical indicators of all the major advanced, life-limiting conditions and multi-morbidity.
  4. Good face validity for health and social care professionals working in hospital, community and care home settings in the UK and internationally.
  5. Promotes early supportive and palliative care in parallel with optimal management of any underlying conditions as part of routine clinical practice.
  6. Contains accessible language and concepts that can be used to initiate discussions with patients and families about goals of care and improve communication between professionals and teams.

SPICTTM may be downloaded from

Initial work in developing SPICTTM for resource poor settings has been undertaken in Nepal and clinicians across Africa are also keen on developing and using the tool.

We propose to establish a working group as part of the SPICTTM international community of practice to develop and test SPICT-RSP (SPICT for resource poor settings).

Any colleagues with experience of delivering palliative care in such areas and who would like to take part can contact Dan Munday –
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