Turkish adaptation of the Supportive and Palliative Care Indicators Tool (SPICT): a validity and reliability study

Abstract

Abstract Background One of the major challenges in clinical practice in Türkiye is the lack of objective criteria for the early identification of patients requiring palliative care. The Supportive and Palliative Care Indicators Tool (SPICT™), developed by Murray SA and colleagues and updated in 2025, is an internationally recognized clinical decision-support tool designed to systematically identify deteriorating health and unmet palliative care needs. This study aims to evaluate the validity and reliability of the Turkish version of the SPICT (SPICT-TR). Methods This descriptive and methodological study was conducted through face-to-face interviews involving 24 physicians and 356 patients. The linguistic adaptation process followed the Beaton protocol and the five-stage translation and cultural adaptation guidelines recommended by the World Health Organization. The data collection form consisted of two sections: sociodemographic information of physicians and patients, and the SPICT-TR along with the "Surprise Question/Reverse Surprise Question." Data were analyzed using descriptive statistics, Chi-square, and Chi-square Exact tests. Internal consistency was evaluated using the Kuder–Richardson 20 (KR-20) coefficient, and inter-rater reliability was assessed using Cohen’s Kappa coefficient. Results The mean age of the 356 patients included in the study was 70.7 ± 11.5 years, with the majority of the sample consisting of patients with multimorbidity. The internal consistency coefficient was found to be KR-20 = 0.87, and the agreement with physicians' clinical assessments was Cohen’s Kappa = 0.93 (p < 0.001). Patients identified as needing palliative care according to SPICT-TR had a significantly higher rate of hospitalization within the last month (p < 0.001). A strong correlation was found between SPICT-TR and Surprise Question responses; specifically, the accuracy of mortality prediction was significant in dementia and malignant diseases (p < 0.001). Conclusions The SPICT-TR is a culturally adapted, valid, and reliable assessment tool for identifying patients with palliative care needs within the Turkish healthcare system. Its high internal consistency and strong agreement with physician clinical judgment suggest that it can serve as a structured support tool in clinical practice. Integrating SPICT-TR into routine practice may contribute to earlier recognition of palliative care needs and timely care planning.