Ethical governance of digital and structured intraoperative family updates: a scoping review of consent, privacy, transparency and trust

Perioperative family updates now include liaison roles, telephone or in-person reports, text messages, secure platforms and electronic status systems. These approaches may reduce uncertainty during surgical waiting but also involve disclosure of health-related information. We mapped these practices and examined how the literature reports consent, authorised recipients, privacy, information boundaries, escalation, accountability, equity, transparency and trustworthiness. We conducted a scoping review reported in accordance with PRISMA-ScR and informed by JBI methodology. PubMed/MEDLINE, Web of Science Core Collection and Academic Search Ultimate were searched on 26 May 2026; CINAHL Complete was added on 28 July 2026 and searched again with a broader practice-sensitive strategy on 14 August 2026. Reference checking and forward citation tracking supplemented database searching. Included sources were classified as direct communication-practice or contextual evidence. Ethical governance was coded at publication level across eight domains using domain- and evidence-role-specific D/S/NR rules. Seventy-three sources were included: 36 direct communication-practice sources and 37 contextual sources. Direct sources comprised 19 digital or technology-mediated and 17 structured non-digital models. Among direct sources, D classifications were most frequent for process transparency (23/36, 63.9%) and accountability/auditability (13/36, 36.1%). Privacy/confidentiality was coded D in 8/36 (22.2%), information boundaries in 7/36 (19.4%), consent/recipient authorisation in 5/36 (13.9%), equity/accessibility in 4/36 (11.1%) and escalation in 1/36 (2.8%). No direct source met the D threshold for trust/trustworthiness; 2/36 were S and 34/36 NR. Contextual sources were analysed separately and were not treated as evidence that safeguards were implemented. Publications described communication delivery more consistently than several governance safeguards, particularly escalation, consent/recipient authorisation and equitable access. Process transparency was often explicit, whereas trust/trustworthiness was rarely examined directly. These findings describe publication-level reporting and operationalisation, not the absence of safeguards in practice. Future reports should make governance arrangements explicit, especially for automated or multi-recipient updates.