Preparing for care planning 

Your care planning appointment is for you to think about:
•	What is important to you.
•	Things you can do to live well and stay well.
•	What care and support you might need to do this.

This letter contains some of your test results and information, along with some questions. This is to help you think ahead and plan what you would like to discuss at your appointment. 

Please bring this to your appointment. The back page will be used to write down the summary and the plans you make.

What are the most important things to you at the moment?	

These are some things that people sometimes want to talk about. Circle any that are important to you.	
		
Sleep	Feeling down or stressed	
		
Medication	Eating the right amount	
		
Memory	Giving up smoking	
		
Food choices	Coping with my day today life	
		
Pregnancy and contraception	Alcohol 	
		
Driving/travel	Keeping active and getting around	
		
Work/benefits/money	Relationships/sex life	
		
Pain/discomfort	My future health	
		
Managing my symptoms	Feeling lonely	

What are the most important things to you at the moment?	

Name:	
GENERAL HEALTH AND WELLBEING ISSUES	
BODY MASS INDEX (BMI)	
Previous 	Latest	Low risk	More risk	High risk	
		20 to 25	25 to 30	Above 30	
WEIGHT (Kg)	Your questions, thoughts, or ideas:	
Previous 	Latest 		
			
Being overweight can make your condition harder to control. It can increase your chances of health problems. 		
SMOKING	
Current smoking status	Low risk	More risk	High risk	
	Non smoker	Ex or passive	Tobacco user	
Stopping smoking is one of the best things you can do to stay healthy.	Your questions, thoughts, or ideas:	
MOOD	
How you feel can make a big difference to your health. 
•	During the last month, have you been bothered by feeling down, depressed, or hopeless?
•	During the last month have you had little interest or pleasure in doing things?
	Your questions, thoughts, or ideas:	

HEART TESTS AND CHECKS	
BLOOD PRESSURE	
Previous	Latest	Low risk	More risk	High risk	
		Less than 140/90	140/90 to 160/100	160/100 or above	
Keeping your blood pressure below 140/90 reduces your risk of health problems (a level below 130/80 is used if you have kidney disease).	Your questions, thoughts, or ideas:	

CHOLESTEROL AND BLOOD FATS	
Previous	Latest	Low risk	More risk	High risk	
		Less than 2.5	2.5 to 4.0	Above 4	
Non-HDL cholesterol is the bad type of fat in your blood. If you have had a heart attack or stroke or have other types of vascular disease you are advised to take statin tablets. Aim for a non-HDL cholesterol below 2.5mmol/L.	Your questions, thoughts, or ideas:	

OTHER TESTS AND CHECKS	
KIDNEY TEST: Blood Test (eGFR)	
Previous	Latest	Low risk	More risk	High risk	
		Above 60	45 to 60	Below 45	
A blood test (eGFR) checks how well your kidneys are working. Your eGFR should be above 60 and be stable.	Your questions, thoughts, or ideas:	
DIABETES SCREENING TEST: HbA1c	
Previous	Latest	Low risk	More risk	High risk	
		Less than 42	42 to 48	Above 48	
Diabetes is more common in people with heart disease. A blood test called HbA1c can detect diabetes. A level above 42 means you are at risk of developing diabetes in the future and over 48 that you may have diabetes.	Your questions, thoughts, or ideas:	
HOW DOES YOUR HEART PROBLEM AFFECT YOU?	
Are symptoms such as angina, chest pain or breathlessness stopping you doing everyday things?	Your questions, thoughts, or ideas:	

LUNG AND BREATHING TESTS AND CHECKS	
OXYGEN SATURATION LEVELS	
My oxygen saturation levels are:	Normal	Increased risk	Severe risk	
	95 to 100%	90 to 95%	Below 90%	
Lung problems can reduce the amount of oxygen in your blood. The healthy range is usually between 95 and 100%.	Your questions, thoughts, or ideas:	
HOW DOES YOUR BREATHING AFFECT YOU?	
You will know how your breathing affects you day to day. There are ways of looking at this that help understand how this is changing each year. This includes ways of scoring your breathing and looking at the number of times you have had chest infections or how many times you have been in hospital for your breathing.	
MRC Score:		Your questions, thoughts, or ideas:	
A way of scoring the level of breathlessness 
(1 = not a problem to 5 = very limited by breathing)		

In the last month have you had difficulty sleeping because of your symptoms?		
In the last month have you had COPD symptoms during the day (cough, wheeze, chest tightness or breathlessness)?		
In the last month has your COPD interfered with your usual activities?		
In the last month have you felt low in mood, anxious or had panic attacks?		
How many flare ups or chest infections have you had in the last 12 months?		
How many times have you been in hospital for your breathing in the last 12 months?		
WHAT MIGHT MAKE A DIFFERENCE:	Thoughts and ideas	
Managing and preventing flare-ups: There are a lot of things you can do to prevent and manage flare-ups such as using inhalers, having rescue drugs, and staying away from people with infections. 		
Exercise and pulmonary rehabilitation: If you have COPD being active and exercising can help you improve your breathing, your fitness, and your quality of life. 
Pulmonary rehabilitation is a programme of activity and education designed for people living with COPD. It combines physical activity sessions with advice and discussions about your lung health.		

Your care planning summary

This will be used to summarise the conversations you have at your care planning appointment and the plan you agree.

Your care planning appointment was with:	Date:	

Summary of the conversation	

Goal setting		Action planning	
What do you want to work on?		What exactly are you going to do?	
What do you want to achieve?		What might stop you and what can you do about it?	
How important is it to you?		How confident do you feel?	
Not important	1  2  3  4  5  6  7  8  9  10	Very important		Not confident	1  2  3  4  5  6  7  8  9  10	Very confident	
	
Follow up/review of goal/action plan:	
When:	Where: