The finding was descriptive and supported by the richness of data. The overall assessment of confidence was moderate, having been downgraded by one increment due to moderate methodological and minor coherence limitations. 4. Improving communication/information flow Review subfinding 4a: Education and joint working GPs expressed a need for education around the identification and diagnosis of heart failure patients; and that with such an improvement in their own understanding their ability to communicate this information to the patient would improve. They felt that changes needed to be made within the health profession first before information on the identification and diagnosis of heart failure can be more clearly communicated to patients (Barnes 2006). Further, in one study cardiology and palliative care staff reported a lack of clarity regarding what had previously been discussed with and disclosed to patients. They recommended mutual education and Chronic Heart Failure Referral and approach to care NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 joint working between the specialties to improve communication to the patient and family (Harding 2008). This subfinding was based on two studies.26, 141 Methodological limitations were rated serious overall. One study had moderate limitations due to limitations in context, role of researcher and data analysis. Another study had 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 overall. Agreement between papers was 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 two studies from the UK in a relevant population. Adequacy was rated as no or very minor concerns. 