TY - JOUR
T1 - Governance frameworks and decision-making models for intensive care units in low- and middle-income countries
T2 - a scoping review protocol
AU - Ghoshal, Arunangshu
AU - Damani, Anuja
AU - Rao, Shwethapriya
AU - Varghese V, Cherian
AU - Salins, Naveen
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: https://creativecommons.org/licenses/by-nc/4.0/.
PY - 2026/3/30
Y1 - 2026/3/30
N2 - INTRODUCTION: Intensive care units (ICUs) operate at the intersection of advanced technology, complex ethical decision-making and resource-intensive care. While many high-income countries have developed institutional governance mechanisms-such as Clinical Ethics Committees, structured triage policies and formal palliative care consultation pathways-to support ethical deliberation and accountability in ICUs, the applicability, structure and reported outcomes of such frameworks in low- and middle-income countries (LMICs) remain unclear and dispersed across disciplines. OBJECTIVE: This scoping review aims to map existing governance frameworks and ethical decision-making models guiding ICU practices globally, with particular attention to their relevance and reported application in LMIC contexts. METHODS: The review will follow the Joanna Briggs Institute methodology and be reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) standards. Searches will be conducted across MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Scopus, Web of Science, PsycINFO and Global Health. Grey literature will be identified through Google Scholar, WHO Global Index Medicus and professional society websites (eg, Indian Society of Critical Care Medicine (ISCCM), Indian Association of Palliative Care (IAPC) and European Society of Intensive Care Medicine (ESICM)). Eligible sources will include empirical research, policy documents, guidelines and institutional reports published in English from 2000 onwards. Data will be charted using a structured template and synthesised through descriptive mapping and thematic analysis across domains, including structural design, decision processes, communication pathways, integration with palliative care, ethical-legal considerations and reported outcomes. The review is planned to be conducted between December 2025 and April 2026, including database searches, screening, data extraction and synthesis. ETHICS AND DISSEMINATION: Ethical approval is not required. Findings will be disseminated through peer-reviewed publications and conference presentations. OSF registration: https://osf.io/tkcav.
AB - INTRODUCTION: Intensive care units (ICUs) operate at the intersection of advanced technology, complex ethical decision-making and resource-intensive care. While many high-income countries have developed institutional governance mechanisms-such as Clinical Ethics Committees, structured triage policies and formal palliative care consultation pathways-to support ethical deliberation and accountability in ICUs, the applicability, structure and reported outcomes of such frameworks in low- and middle-income countries (LMICs) remain unclear and dispersed across disciplines. OBJECTIVE: This scoping review aims to map existing governance frameworks and ethical decision-making models guiding ICU practices globally, with particular attention to their relevance and reported application in LMIC contexts. METHODS: The review will follow the Joanna Briggs Institute methodology and be reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) standards. Searches will be conducted across MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Scopus, Web of Science, PsycINFO and Global Health. Grey literature will be identified through Google Scholar, WHO Global Index Medicus and professional society websites (eg, Indian Society of Critical Care Medicine (ISCCM), Indian Association of Palliative Care (IAPC) and European Society of Intensive Care Medicine (ESICM)). Eligible sources will include empirical research, policy documents, guidelines and institutional reports published in English from 2000 onwards. Data will be charted using a structured template and synthesised through descriptive mapping and thematic analysis across domains, including structural design, decision processes, communication pathways, integration with palliative care, ethical-legal considerations and reported outcomes. The review is planned to be conducted between December 2025 and April 2026, including database searches, screening, data extraction and synthesis. ETHICS AND DISSEMINATION: Ethical approval is not required. Findings will be disseminated through peer-reviewed publications and conference presentations. OSF registration: https://osf.io/tkcav.
UR - https://www.scopus.com/pages/publications/105034818299
UR - https://www.scopus.com/pages/publications/105034818299#tab=citedBy
U2 - 10.1136/bmjopen-2026-117708
DO - 10.1136/bmjopen-2026-117708
M3 - Article
C2 - 41916636
AN - SCOPUS:105034818299
SN - 2044-6055
VL - 16
SP - e117708
JO - BMJ Open
JF - BMJ Open
IS - 3
ER -