Life In The Slower Lane

Here is the structured PICO analysis for the sixth article you uploaded:

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Full Title (verbatim and exact):

“Implementation and evaluation of the Supportive and Palliative Care Indicators Tool (SPICT™) in acute care”

Paulik O, Whitaker R, Mesuria M, et al.

Australasian Journal on Ageing, 2024; 43:591–599

DOI: https://doi.org/10.1111/ajag.13308

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Type of Article:

Retrospective observational audit study

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PICO Analysis:

Population:

• 153 patients admitted to an acute aged care precinct in a metropolitan tertiary referral hospital (Sydney, NSW)
• Mean age: 84.1 years
• 37% admitted from residential aged care
• All had age-related or life-limiting conditions; 99% were SPICT™-positive, with high levels of frailty, dementia, or multi-morbidity 

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Intervention:

• Use of the Supportive and Palliative Care Indicators Tool (SPICT™) to:
  • Identify patients at risk of deterioration or death within 12 months
  • Trigger advance care planning (ACP) conversations and documentation
• Tool involves assessment of:
  • ≥2 general indicators (e.g. dependency, weight loss)
  • ≥1 clinical indicator (e.g. dementia, cancer, organ failure)

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Comparator:

• No explicit control group
• Internal comparison based on outcomes at 6 and 12 months post-SPICT™ assessment and adherence to ACP documentation

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Outcome:

1. Person-centred outcomes:

• Mortality rates:
  • 36% at 6 months
  • 39% at 12 months
• Mean SPICT™ score significantly higher among those who died, indicating predictive value for early deterioration
• Only 16% of SPICT-positive patients had ACP documented, and 30% had active resuscitation plans (e.g., ICU, CPR), raising concerns of futile intervention in a frail cohort 

2. Process outcomes:

• Assessment showed 99% SPICT positivity, but poor adherence to ACP documentation in eMR
  • Only 15% had completed ACP tab
  • 64% had NFR documented, but often without linked ACP notes
• Documentation quality improved only after systematic changes to the eMR (new ACP tab introduced post-study)

3. Health system outcomes:

• Identified a missed opportunity for timely goals-of-care discussions and avoidance of potentially costly and non-beneficial interventions
• Recommendations include early SPICT™ screening, enhanced training for clinicians, and systemic improvements to ACP workflows

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