How prognostic information influences care planning in adult intensive care units: protocol for a realist review

Prognostic information plays a key role in decision-making in adult intensive care units (ICUs), but its influence on advance care planning, treatment limitation and palliative-care integration depends on organisational, legal, cultural and relational factors. This review focuses on how prognostic information is used in decision-making processes. This realist review will explore how, why, for whom and in which ICU contexts prognostic information impacts care planning.

Following Realist and Meta-narrative Evidence Syntheses (RAMESES) publication standards for realist syntheses, we will iteratively develop an initial programme theory (IPT) and refine context-mechanism-outcome (CMO) configurations through staged database and grey literature searches, selecting sources based on relevance and rigour, performing theory-driven extraction and applying realist synthesis strategies (juxtaposition, reconciliation, adjudication and consolidation). Stakeholders, including ICU and palliative care clinicians, caregiver representatives and ethics/policy advisors, will contribute to shaping IPT development, CMO refinement and interpretation. Reporting will also adhere to Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines; the completed checklist is provided as Supplementary File S1.

Ethical approval is not required (secondary analysis).

Findings will be disseminated through peer-reviewed publications, conference presentations and stakeholder-targeted briefs for clinicians, policymakers and professional bodies.

Open Science Framework (OSF: https://osf.io/6qu8x).