Four studies were rated moderate limitations: each due to a number of limitations that included some of the following; limitations in context, role of researcher, data analysis, research method rigour, and/or data richness in some sections relevant to this review. Two studies were rated serious limitations due to lack of reflection on researcher role in the study, limited context and data richness, plus lack of reasoning for choice of methods in one study and limitations in data collection for the other. One study was rated very serious limitations due to the limited information on the background and reflection of the researcher, data collection, data richness, relevance of findings and link to conclusions. Coherence was rated no or very minor concerns. Agreement between papers was very good. Relevance was rated no or very minor concerns. The relevance of the subfinding to the focus of the review was very high. The data stemmed from seven studies from the UK in a relevant population. Adequacy was rated as no or very minor concerns. The subfinding was explicitly supported by seven studies, and it was illustrated in much detail. The overall assessment of confidence was high, as the moderate limitations in methodology were offset by the richness of data provided by these seven studies. Review subfinding 4d: Improving access to information Patients who wished for more information sought a better understanding of the disease process, the practical limitations, how to get help and how to cope with living with heart failure Horne 2004). Some people with heart failure wished to be told openly and sensitively about their (poor) prognosis by clinicians, with some wanting to know more accurately when they would die. 