The committee acknowledged that discussion of prognosis should be a gradual process and may not necessarily be discussed in the first consultation as it is highly difficult to predict, particularly in the early stages of the condition. The prognosis needs to be discussed in a sensitive, open and honest manner, ensuring that the unpredictability of the prognosis and any uncertainty regarding life expectancy is conveyed. The positive effects of treatments available should also be discussed. The group acknowledged the difficulty patients may have coming to terms with information around their Chronic Heart Failure Domiciliary oxygen therapy in people with advanced heart failure NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 own prognosis which highlights the importance of an immediate follow-up consultation and the engagement of family/carers (where the patient consents to their presence). This consultation provides reinforcement of the key implications of the diagnosis and prognosis and, especially where a family member or carer is present, clarification of any misperceptions. To facilitate a quick rapport with the patient and to tailor information to the patient s needs (in line with the recommendations of the patient experience guideline), the consultant committee members suggested including any preferences the patient had, regarding the level and type of information they want to be given, into the referral form from primary care. Another suggestion was for patients to complete a simple questionnaire before the first appointment identifying key areas they would like to discuss during the consultation. The committee acknowledged that the communication of these challenging issues requires specific skills that not all healthcare professionals have, and supported the provision of training in advanced communication skills to all heart failure staff. Specific information on heart failure issues could be incorporated into broader communication training for chronic or life-limiting conditions. 