Age: mean 66 Identify the needs of caregivers supporting a person with heart failure and inform the development of a caregiver resource to be used as part of a home- based self- management programme. Setting: Cornwall, Birmingham and Leicester, UK. Abbreviations: Pt = people with chronic heart failure, HCP = healthcare professional, NYHA = New York Heart Association Functional Classification, COPD = chronic obstructive pulmonary disease 9.4.3.3 Qualitative evidence synthesis Table 139: Review findings Main findings Statement of finding Diagnosis of heart failure 1a. Communication is challenging Clinicians find the diagnosis itself and the ensuing communication around diagnosis challenging. 1b. Timing and setting Choosing the timing and setting of communicating the diagnosis is important. Chronic Heart Failure Referral and approach to care NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 Main findings Statement of finding 1c. Gradual process The persons comprehension of their diagnosis is seen as a gradual process which results in information and guidance around diagnosis being relayed to patients in a gradual manner. 1d. Terminology 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. Understanding heart failure 2a. Understanding of diagnosis Although there is variability in patients understanding of their diagnosis it is generally poor. 2b. Knowledge and management Patients desire for more knowledge about their condition and its management is highly individual. Discussion of prognosis 3a. Difficult conversations Staff reported difficulties in discussing prognosis and future care options due to the unpredictable disease trajectory, uncertainty whether patients wanted to know and difficulties handling emotional involvement of patients and their families. 3b. Understanding of prognosis Patients described that prognosis was rarely discussed and showed that their understanding of their prognosis was generally poor. 