Development and evaluation of the Supportive and Palliative Care Indicators Tool (SPICT): a mixed-methods study
Development and evaluation of the Supportive and Palliative Care Indicators Tool (SPICT): a mixed-methods study
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DOI：
10.1136/bmjspcare-2013-000488
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发表时间：
2014-09-01
影响因子：
2.7
通讯作者：
Boyd, Kirsty
中科院分区：
文献类型：
--
作者：
Highet, Gill;Crawford, Debbie;Boyd, Kirsty
目的完善和评估一个实用的，临床的工具，以帮助在英国和国际上的多学科团队，以确定在所有护理settings.Methods恶化和死亡的风险患者，我们采用了参与式研究的方法，完善2010年的支持和姑息治疗指标工具（SPICT），并评估其在临床实践中的使用。我们通过一个开放获取的网页进行了为期18个月的持续同行评议，并邀请了来自英国和国际上的30多名临床医生开发一个有效的工具。其次，我们在苏格兰东南部的一家急性病医院进行了前瞻性病例发现研究。四个多学科的团队确定了130例晚期肾脏，肝脏，心脏或肺部疾病后，计划外hospitaladmission.Results SPICT进行了改进和更新，包括容易识别的，一般指标相关的患者与任何先进的疾病，和疾病的具体指标常见的先进条件。医院临床医生使用SPICT来识别有恶化和死亡风险的患者。死亡的患者有更多的计划外入院，持续的症状和增加的护理需求。到12个月时，62名（48%）确定的患者死亡。69%的人死在医院，花了22%的最后6 months.Conclusions SPICT可以支持多学科团队的临床判断时，确定患者的恶化和死亡的风险。它有助于识别有多种未满足需求的患者，这些患者将从早期的整体需求评估，护理目标审查和预期护理计划中受益。
Objective To refine and evaluate a practical, clinical tool to help multidisciplinary teams in the UK and internationally, to identify patients at risk of deteriorating and dying in all care settings.Methods We used a participatory research approach to refine the 2010 Supportive and Palliative Care Indicators Tool (SPICT) and evaluate its use in clinical practice. We conducted an ongoing peer review process for 18 months via an open access webpage, and engaged over 30 clinicians from the UK and internationally in developing an effective tool. Secondly, we carried out a prospective case-finding study in an acute hospital in SE Scotland. Four multidisciplinary teams identified 130 patients with advanced kidney, liver, cardiac or lung disease following an unplanned hospital admission.Results The SPICT was refined and updated to consist of readily identifiable, general indicators relevant to patients with any advanced illness, and disease-specific indicators for common advanced conditions. Hospital clinicians used the SPICT to identify patients at risk of deteriorating and dying. Patients who died had significantly more unplanned admissions, persistent symptoms and increased care needs. By 12 months, 62 (48%) of the identified patients had died. 69% of them died in hospital, having spent 22% of their last 6 months there.Conclusions The SPICT can support clinical judgment by multidisciplinary teams when identifying patients at risk of deteriorating and dying. It helped identify patients with multiple unmet needs who would benefit from earlier, holistic needs assessment, a review of care goals, and anticipatory care planning.