They found that at a technical level it crossed their mind that it should be switched off, but that for some it wouldn't cross their mind to initiate a conversation with the patient. Doctors reported that it was hard to bring up discussions about deactivation because this contrasted so much with their discussions about the primary lifesaving role of the devices, and therefore initiating discussions of deactivation felt as though they were shutting off hope for patients. Others also didn t feel like they could bring up such a difficult topic if they didn t have a good relationship or rapport with the patient. Similarly nurses felt that doctors were uncomfortable having discussions about end of life issues because they are not trained to manage these situations. Healthcare professionals felt that in particular cardiology teams were reluctant to take the lead on decision-making. Some healthcare professionals also felt that electrophysiology services were unwilling to have conversations and make decisions regarding deactivation. Explanation of quality assessment: moderate methodological limitations in the studies contributing to this sub-finding; minor concerns about the coherence; partial relevance due to most of the contributing studies being conducted outside of the UK; minor concerns about inadequacy as the evidence provided reasonable depth. There was an overall judgement of moderate confidence in this sub-finding due to the concerns regarding the methodological limitations and relevance. 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. 