There was an overall judgement of low confidence in this sub-finding due to the concerns regarding relevance and adequacy. Review sub-finding 6: Starting the conversation early Some ICD recipients felt that discussions should be initiated early. They felt it should be pre-implant and while they were still cognitively intact ; many felt that at this time they wanted the issue to be described to them fully, so that they were aware of the issues around deactivation but did not have to make any decisions at that point. Patients did not feel it was appropriate to have discussions about ICD deactivation at the end of life when death was imminent. They also highlighted the role of healthcare professionals in allowing them to make a fully informed decision about ICD implantation. They suggested they could be given written information. Those that had already had this discussion said it was good to do this early while they were already engaged in ICD discussions with their healthcare professionals, and some that hadn't had the conversation felt that they wanted to do so soon. Healthcare professionals felt that deactivating ICDs was unlike any other decisions they had to make, and so it was difficult for them to know when discussions should take place. They felt that ICD deactivation was not discussed early enough, which meant devices were not deactivated in time. They also felt there was a lack of forward planning in the community. Others felt that discussions did take place upon insertion but these are usually forgotten by the time they come into focus when the person s condition has deteriorated. 