{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T14:02:39Z","timestamp":1782741759232,"version":"3.54.5"},"reference-count":37,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:00:00Z","timestamp":1782691200000},"content-version":"unspecified","delay-in-days":28,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001411","name":"Indian Council of Medical Research","doi-asserted-by":"publisher","award":["CAR-2024-01-000500\/F2\/F3"],"award-info":[{"award-number":["CAR-2024-01-000500\/F2\/F3"]}],"id":[{"id":"10.13039\/501100001411","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,5,29]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethical approval is not required (secondary analysis).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Dissemination<\/jats:title>\n                    <jats:p>Findings will be disseminated through peer-reviewed publications, conference presentations and stakeholder-targeted briefs for clinicians, policymakers and professional bodies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Registration<\/jats:title>\n                    <jats:p>\n                      Open Science Framework (OSF:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/osf.io\/6qu8x\">https:\/\/osf.io\/6qu8x<\/jats:ext-link>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-117449","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T13:34:41Z","timestamp":1782740081000},"page":"e117449","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["How prognostic information influences care planning in adult intensive care units: protocol for a realist review"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9975-2568","authenticated-orcid":false,"given":"Arunangshu","family":"Ghoshal","sequence":"first","affiliation":[{"name":"Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India - 576104"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashmitha","family":"Prasad","sequence":"additional","affiliation":[{"name":"Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India - 576104"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aparna","family":"Nanda","sequence":"additional","affiliation":[{"name":"Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India - 576104"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naveen","family":"Salins","sequence":"additional","affiliation":[{"name":"Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India - 576104"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,29]]},"reference":[{"key":"2026062906303526000_16.6.e117449.1","doi-asserted-by":"crossref","first-page":"1438","DOI":"10.1007\/s00134-024-07565-7","article-title":"Assessing palliative care practices in intensive care units and interpreting them using the lens of appropriate care concepts. 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