Limitations Moderate concerns about methodological limitations MODERATE Coherence No or very minor concerns about coherence Relevance No or very minor concerns about relevance Adequacy Minor concerns about adequacy Diagnosis of heart failure 1b. Timing and setting Individual interviews with pt + carers and focus groups with HCPs Ethnographic study involving pt and HCPs Open-ended narrative interviews with pt Choosing the timing and setting of communicating the diagnosis is important. Limitations Moderate concerns about methodological limitations MODERATE Coherence Minor concerns about coherence Relevance No or very minor concerns about relevance Referral and approach to care Chronic Heart Failure NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: Study design and sample size Finding Quality assessment Number of studies contributing to the finding Design Criteria Rating Overall assessment of confidence Adequacy No concerns about adequacy Diagnosis of heart failure 1c. Gradual process Individual interviews with pt + carers and focus groups with HCPs Secondary analysis of interview transcripts of pt. Ethnographic study involving pt and HCPs The diagnosis itself is seen as a gradual process which results in information and guidance around diagnosis being relayed to patients in a gradual manner. Limitations Moderate concerns about methodological limitations MODERATE Coherence No or very minor concerns about coherence Relevance No or very minor concerns about relevance Adequacy No concerns about adequacy Diagnosis of heart failure Semi-structured interviews with pt + carers Individual interviews with pt + carers and focus groups with HCPs Secondary analysis of interview transcripts of pt. In-depth interviews with pt and following bereavement interviews with informal carers As the term heart failure is seen by healthcare professionals as anxiety-invoking, many make use of euphemisms or even more complex terminology instead which is often confusing for patients. 