Understanding of prognosis Patients described that prognosis was rarely discussed and showed that their understanding of their prognosis was generally poor. 3c. Patients concerns Whilst patients desire for more knowledge about their prognosis was highly individual many were worried by the uncertainty of what the future held. Improving communication/ information flow 4a. Education and joint working Staff identified that communication with patients and family members would be improved through training in diagnosing and prognosticating heart failure, and through mutual education for staff from different specialities. 4b. Ongoing relationship Staff suggested for information and education to be delivered to the patient within an ongoing relationship and in an appropriate setting. 4c. Tailoring of information The variability in patients ability and willingness to receive information regarding their condition requires staff to tailor the information to the needs of the individual. 4d. Improving access to information Patients desire more detail, written information and greater access to support. 9.4.3.3.1 Narrative summary of review findings The review findings are grouped within four overarching findings, as follows: 1. Diagnosis of heart failure 2. Understanding heart failure 3. Discussion of prognosis 4. Improving communication/information flow Each of these four findings contain several key subfindings that are described below along with an evaluation of the quality including an explanation for the CerQual grading that appears with the subfindings in the summary tables in section 1.3.4. Chronic Heart Failure Referral and approach to care NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 1. Diagnosis of heart failure Review subfinding 1a: Communication is challenging Clinicians find the first conversation disclosing the diagnosis of heart failure to the patient to be difficult. Some clinicians described the diagnosis of heart failure itself as challenging, making it even more difficult to relay information to patients. 