Preferences about the timing of the discussion were also varied. Some ICD recipients felt that discussions should be initiated early, pre-implant, as part of the informed consent process, rather than having the discussions at the end of life when death was imminent. Other ICD recipients felt that ICD deactivation should be discussed if their condition had deteriorated significantly and they were nearing the end of their life, with some specifically expressing views that deactivation not be raised at the time of implantation due to the resulting emotional distress and overwhelming nature of the information. Healthcare professionals reported that it was difficult for them to know when these discussions should take place. Some felt that it was often not discussed early enough which delayed deactivation occurring; others reported that discussions taking place at the time of implantation are usually forgotten by the time they become relevant; when a person s condition deteriorates. ICD recipients, family members and healthcare professionals all reported avoiding discussions about ICD deactivation, due to the difficult nature of the conversations. Decision making: there was a dichotomy in the evidence on who should decide whether an ICD should be deactivated. People with ICDs and their family members often felt that healthcare professionals should decide whether it was appropriate for their ICD to be deactivated, as they did not feel qualified or comfortable making the decision themselves. Healthcare professionals felt that ICD recipients should be the ones to decide whether to deactivate their device in the context of end of life discussions. Some healthcare professionals felt that families sometimes put pressure on patients to keep their device active. Healthcare professionals reported practical challenges in the deactivation of ICDs after a decision had been made. 