[2018] Findings identified in the evidence synthesis The evidence from the review was grouped into 3 findings, each of which contained multiple sub-findings. These key findings are summarised below. Attitudes and understanding: many ICD recipients were not aware that their ICDs could be deactivated, with their doctors not discussing this with them. Other recipients had misconceptions about the effect of deactivation, perceiving it to be equivalent to euthanasia or assisted suicide, leading to immediate death. Whether ICD recipients would consider deactivation or not was highly varied. Some recipients reported that they would not consider living without their ICD as they believed it was keeping them alive. Similarly, some recipients felt that their ICD should never be deactivated when it could 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 extend their life, regardless of the circumstances. Some people were scared to deactivate. Other ICD recipients felt that they would deactivate their device when their quality of life was so low that they were bedridden or unable to engage in daily activities, if they were in a lot of pain and had received numerous shocks, or if they were elderly and felt they may be ready to die soon. Some family members and healthcare professionals reported similar sentiments about deactivation being appropriate in these circumstances. Discussions: preferences and experiences on initiating the conversation about deactivation were varied. Some ICD recipients felt that healthcare professionals should initiate the discussion, whereas others felt this would be too emotionally distressing. Nurses felt they were often the ones to raise the conversation during the dying process. Doctors reported that guidelines on how to initiate the conversation were unclear. Preferences about the timing of the discussion were also varied. 