Governance frameworks and decision-making models for intensive care units in low- and middle-income countries: a scoping review protocol.

Abstract

<h4>Introduction</h4>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.<h4>Objective</h4>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.<h4>Methods</h4>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.<h4>Ethics and dissemination</h4>Ethical approval is not required. Findings will be disseminated through peer-reviewed publications and conference presentations. OSF registration: https://osf.io/tkcav.