English:

The SPICT-TW™ (Taiwan) has been developed and validated by the HOme-based Longitudinal Investigation of the MultidiSciplinary Team Integrated Care (HOLISTIC) investigators in collaboration with nationwide Taiwanese colleagues working for primary care in the community. The HOLISTIC study was funded and conducted by National Health Research Institutes, Taiwan and the Taiwan Society of Home Health Care, with the leadership by Professor Chao A. Hsiung, Dr. Ping-Jen Chen, and Dr. Sang-Ju Yu.

The speed of population aging in Taiwan ranks among the highest in the world. The ratio of older people aged 65 and above is expected to increase from 14% to 21% within just ten years, and by 2026, Taiwan will become a ‘Super-Aged Society.’ The Silver Tsunami will have a significant impact on the healthcare system. A critical national issue is constructing a person-centred, care needs-driven, and community-based integrated care system.

Taiwan launched its National Health Insurance (NHI) program in 1995, a universal single-payer health service scheme that covers more than 99% of legal residents. Since 1996, the NHI has reimbursed home-based palliative care, gradually expanding to include palliative care units and inpatient palliative liaison care after 2000. More importantly, in 2009, NHI extended palliative care services to non-cancer patients, including those with dementia, strokes, various organ failures, etc.

In 2022, NHI’s palliative care services were expanded to older people with severe frailty and individuals with disease categories specified in the 2016 Patient’s Right to Autonomy Act, including permanent vegetative status, irreversible coma, various neurodegenerative diseases, rare diseases, and more. As we move towards a paradigm of palliative care that focuses not only on end-of-life periods or limited diseases but also on offering care without the wall, SPICT-TW serves as a practical tool for healthcare teams, as well as patients and caregivers.

SPICT-TW is not just a tool for assessing when to initiate specialised palliative care, nor is it designed for survival prognosis or as a substitute for the commonly used ‘surprise question’ in palliative care initiation. The core objective of SPICT-TW is to facilitate the timely identification and assessment of palliative care needs when there are changes in a person’s overall health status, an increased risk of health deterioration, or a growing need for care and support. It aims to enhance discussions about appropriate care plans and coordinate communication among relevant persons involved in the care provision, whether health or social care professionals with varying expertise in palliative care, and whether in the community or a hospital.