Validation of the Supportive and Palliative Care Indicators Tool in a Geriatric Population

J Palliat Med. 2018 Feb;21(2):220-224. doi: 10.1089/jpm.2017.0205. Epub 2017 Aug 9.


Background: Timely identification of patients in need of palliative care is especially challenging in a geriatric population because of prognostic uncertainty. The Supportive and Palliative Care Indicators Tool (SPICTâ„¢) aims at facilitating this identification, yet has not been validated in a geriatric population.

Objective: This study validates the SPICT in a geriatric patient population admitted to the hospital.

Design: This is a retrospective cohort study.

Setting: Subject were patients admitted to the acute geriatric ward of a Belgian university hospital between January 1 and June 30, 2014.

Measurements: Data including demographics, functional status, comorbidities, treatment limitation decision (TLD), and one-year mortality were collected. SPICT was measured retrospectively by an independent assessor.

Results: Out of 435 included patients, 54.7% had a positive SPICT, using a cut-off value of 2 for the general indicators and a cut-off value of 1 for the clinical questions. SPICT-positive patients were older (p = 0.033), more frequently male (p = 0.028), and had more comorbidities (p = 0.015) than SPICT-negative patients. The overall one-year mortality was 32.2%, 48.7% in SPICT-positive patients, and 11.5% in SPICT-negative patients (p < 0.001). SPICT predicted one-year mortality with a sensitivity of 0.841 and a specificity of 0.579. The area under the curve of the general indicators (0.758) and the clinical indicators of SPICT (0.748) did not differ (p = 0.638). In 71.4% of SPICT-positive cases, a TLD was present versus 26.9% in SPICT-negative cases (p < 0.001).

Conclusion: SPICT seems to be valuable for identifying geriatric patients in need of palliative care as it demonstrates significant association with one-year mortality and with clinical survival predictions of experienced geriatricians, as reflected by TLDs given.

Keywords: SPICT; TLD; geriatric palliative care; prognostication.

Publication types

  • Validation Study

MeSH terms

  • Aged, 80 and over
  • Belgium
  • Cohort Studies
  • Decision Making
  • Decision Support Techniques*
  • Female
  • Frail Elderly / statistics & numerical data*
  • Health Status Indicators*
  • Hospitals, University
  • Humans
  • Male
  • Needs Assessment / statistics & numerical data*
  • Palliative Care / statistics & numerical data*
  • Psychometrics
  • Retrospective Studies
  • Sensitivity and Specificity
  • Socioeconomic Factors