Heart failure specialist nurses and GPs were seen as key to the success of this process. This subfinding was based on three studies.26, 133, 207, 313 Methodological limitations were rated moderate concerns overall. Two studies were rated as moderate limitations due to a lack of context and role of the researcher, plus data analysis in one study and data richness in the other. One study had serious limitations due to the secondary use of data and the subsequent inability to assess their methodology in detail, along with vague description of the analysis. Coherence was rated no or very minor concerns overall. Agreement between papers was good. Relevance was rated no or very minor concerns overall. The relevance of the subfinding to the focus of the review was very high. The data stemmed from three studies from the UK in a relevant population. Adequacy was rated as no or very minor concerns. The subfinding was general, and although explicitly supported by a limited number of studies, other studies found similar themes. The finding was descriptive and the richness of data was sufficient for this. The overall assessment of confidence was moderate, having been downgraded by one increment due to the concerns in methodology. Review subfinding 1d: Terminology Clinicians stated that they felt that the terminology affected communication. They wanted patients to understand their condition but also wished to avoid upsetting them and extinguishing their hope. Only very few healthcare professionals described using the term heart failure ; it was regarded by most of them as an anxiety-invoking term (similar to a cancer diagnosis). So instead many resorted to using euphemisms (e.g. ageing heart , stiff heart , heart not pumping efficiently ) or paradoxically even more complex terminology (e.g. left ventricular failure ). 