Palliative Care


Earlier identification of people who benefit from a palliative approach to care leads to more proactive person-centered care.

Earlier recognition of decline leads to:

  • Earlier anticipation of likely needs
  • Better planning
  • Fewer crisis hospital admissions
  • Tailored care that respects people's wishes

This in turn results in better outcomes with more people living and dying in the place and manner of their choice (Gold Standards Framework, 2016).

There are different tools that can help you identify people who might benefit from a palliative approach to care, starting with the Surprise Question.


Surprise Question

First, for patients with advanced disease or progressive life-limiting conditions, ask yourself:

Would you be surprised if the patient were to die in the next year, months, weeks, days?

The answer should be intuitive, pulling together a range of clinical, social and other factors that give a whole picture of deterioration.

If you would not be surprised, what measures might be taken to improve the patient’s quality of life now and in preparation for possible further decline?

If you are not certain how you would answer this question, consider using either the Gold Standards Framework or the SPICT™ to help guide you further. Both of these tools provide general and disease-specific indicators of decline to help you identify people whose health is deteriorating.

Gold Standards Framework

This updated 6th edition of the GSF PIG, renamed as Proactive Identification Guidance and formally known as Prognostic Indicator Guidance, aims to enable the earlier identification of people nearing the end of their life who may need additional supportive care.

This includes people who are nearing the end of their life following the three main trajectories of illness for expected deaths:

  • Rapid predictable decline (e.g. cancer)
  • Erratic decline (e.g. organ failure)
  • Gradual decline (e.g. frailty and dementia)

Additional contributing factors when considering prediction of likely needs include:

  • Current mental health
  • Co-morbidities
  • Social care provision


The SPICT™ is used to help identify people whose health is deteriorating and asses them for unmet supportive and palliative care needs. When using SPICT™ :

  • Look for any general indicators of poor or deteriorating health
  • Look for clinical indicators of one or multiple life-limiting conditions
  • Review current care and care planning