Quality of the evidence The confidence ratings for the different sub-findings in the review were varied, ranging from high to low. The members weighed the confidence in the individual findings with their own experiences, and agreed that they were broadly consistent. Diagnosis of heart failure: All 4 sub-findings within this finding, namely communication is challenging, timing and setting, gradual process and terminology, were rated as moderate confidence. This was mainly due to methodology concerns, as well as minor coherence limitations in a 2 findings 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 and minor adequacy limitations in 1 sub-finding. Understanding heart failure: Both sub-findings within this finding, understanding of diagnosis and knowledge and management, were rated as low confidence having, in both instances, been downgraded by 2 increments due to concerns over methodology and coherence. Discussion of prognosis: All 3 sub-findings within this finding, namely difficult conversations, understanding of prognosis, and patients concerns, were rated as moderate confidence. This was mainly due to limitations in methodology, as well as minor coherence limitations for the last 2 sub- findings. Improving communication/information flow: Two sub-findings (education and joint working and improving access to information) were rated as moderate confidence having been downgraded mainly due to serious methodological limitations. The other 2 sub-findings within this finding, ongoing relationship and tailoring of information, were rated as high confidence as the moderate methodological concerns were offset by the data richness provided by the studies. Trade-off between benefits and harms The committee agreed that the findings and sub-findings identified in the review resonated with their own experiences as healthcare professionals or patients within heart failure services in the NHS. 