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‘Supportive and Palliative Care Indicators Tool (SPICT) improves renal nurses’ confidence in recognising patients approaching end of life’
  1. Laura Lunardi1,
  2. Kathy Hill2,
  3. Susan Crail1,
  4. Adrian Esterman2,
  5. Richard Le Leu1 and
  6. Christine Drummond3
  1. 1 Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
  2. 2 Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
  3. 3 Central Adelaide Palliative Care Service, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
  1. Correspondence to Laura Lunardi, Renal Department, Central Adelaide Local Health Network, Adelaide SA 5000, Australia; laura.lunardi{at}


Background Identification 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.

Objectives To improve renal nursing staff confidence in identifying patients approaching end-of-life and advocate for appropriate multidisciplinary care planning.

Design This 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.

Results Several 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.

Conclusion The 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.

  • renal failure
  • end of life care
  • clinical assessment
  • education and training
  • supportive care

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information. Deidentified participant data.

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Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information. Deidentified participant data.

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  • Contributors LL conceived and conducted the research and contributed to the manuscript, KH contributedto the manuscript, SC contributed to the manuscript and AE analysed the data, RL and CDcontributed to drafted the manuscript and with staff education.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.