Finding 3: Decision making Review sub-finding 9: Healthcare professionals decide People with ICDs wanted to put the decision to deactivate their ICD in the hands of healthcare professionals rather than making an active choice themselves about deactivation. They felt that it was difficult for them to make a decision themselves because they weren t qualified and that clinicians should come up with the suggestion themselves; they trusted the decisions that their Chronic Heart Failure Advanced heart failure and palliative care NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 healthcare professionals made. Spouses also felt that they would rather healthcare professionals make decisions about deactivation so they did not have to make the decisions themselves. Healthcare professionals reported reasons they were unable to deactivate ICDs, even if they had decided to deactivate. For example, deactivation was often not possible out of hours, when staff or magnets were unavailable in community hospitals. Some healthcare professionals found that consultants were unavailable to visit dying patients in the community in order to deactivate ICDs. Others spoke of excessive time delays due to a lack of defined process in the community, unavailability of magnets or insufficient education on how to use magnets and confusion of the size of the magnet needed. Others spoke of organisational difficulties, having to make lots of phone calls in order to access technician support for deactivation. Many felt that there was no local or national policy or procedures related to ICD deactivation, which made the process long and difficult. Explanation of quality assessment: moderate methodological limitations in the contributing studies; minor concerns about the coherence with nothing to lower confidence; partial relevance due to the contributing studies being conducted outside of the UK; minor concerns about inadequacy as the evidence provided reasonable depth. 