Person-centred assessment

Managing the long-term effects of COVID-19 (SIGN/NICE/RCGP)
Healthcare Improvement Scotland

Related information: Clinical case definitions

Rationale

The evidence suggested that healthcare professionals should use a holistic approach to assessment and the panel agreed that assessment should cover both symptoms and how they affect the person overall. Evidence from patient experience showed that many people feel their symptoms are not taken seriously. There are also people who don't realise that their symptoms are connected with COVID‑19, so taking time to listen, showing empathy, taking a careful history and making an assessment are important.

The panel reviewed evidence on the case definition for the November 2021 update, which emphasised the fluctuating nature of symptoms, so they agreed to retain the recommendation on this topic.

Recommendations

RecommendationFor people with ongoing symptomatic COVID-19 or suspected post-COVID-19 syndrome who have been identified as needing an assessment, use a holistic, person-centred approach. Include a comprehensive clinical history and appropriate examination that involves assessing physical, cognitive, psychological and psychiatric symptoms, as well as functional abilities.

RecommendationInclude in the comprehensive clinical history: 

  • history of acute COVID-19 (suspected or confirmed)
  • the nature and severity of previous and current symptoms
  • timing and duration of symptoms since the start of acute COVID-19
  • history of other health conditions
  • exacerbation of pre-existing conditions.
RecommendationBe aware that people can have wide-ranging and fluctuating symptoms after acute COVID-19, which can change in nature over time.
 This content is derived from the Scottish Government's Implementation Support Note.
It should be recognised that many people may have multiple symptoms, and over time more than one appointment may be needed to assess a person’s physical, psychological and social concerns. Where possible continuity of care, and shared decision making which supports good care planning conversations (and anticipatory care plans where appropriate) will support positive therapeutic relationships, with the GP as the expert medical generalist working with the extended multidisciplinary team to support a person’s management across health and care.
RecommendationDiscuss the person’s experience of their symptoms and how their life and activities have been affected, including work, education, mobility and independence. Ask about any feelings of worry or distress. Listen to their concerns with empathy and acknowledge the impact on their day-to-day life. 
  This content is derived from the Scottish Government's Implementation Support Note.
Consider individuals' lived experience of symptoms, and how this affects their physical, psychological and social wellbeing.
  This content is derived from the Scottish Government's Implementation Support Note.
Manage expectations around waiting times, the potential outcomes of any investigations regarding management and who will update the patient on the outcomes of investigations, as part of a care planning conversation.

Rationale

Some people may need help to describe their symptoms, including those who experience cognitive symptoms, such as 'brain fog', confusion and loss of memory, after acute COVID-19. The panel highlighted the value of talking to family members or carers, with the person’s agreement, to help get a full clinical picture for people who need extra support with communication.

Recommendation

RecommendationFor people who may benefit from support during their assessment, for example to help describe their symptoms, include a family member or carer in discussions if the person agrees.

For more advice on supporting adults to make their own decisions if they lack mental capacity, see NICE's guideline on decision-making and mental capacity and the Adults with Incapacity Act (Scotland) (2000), with further guidance available from the Mental Welfare Commission for Scotland.

References

Full details of the evidence and the panel's discussion are in the evidence reviews on: