Evaluation of the impact of an interdisciplinary team scheduling model on psychological outcomes in patients with decompensated cirrhosis

Abstract

BACKGROUND

Patients with decompensated cirrhosis frequently experience severe psychological distress, anxiety, and depression, yet psychological support is often fragmented in conventional care.

AIM

To investigate the effect of interdisciplinary team scheduling on psychological outcomes in decompensated cirrhosis.

METHODS

A randomized, single-blind, single-center trial was conducted from January 2022 to December 2024 in Guangxi Zhuang Autonomous Region. A total of 110 patients with decompensated cirrhosis (Distress Thermometer ≥ 4) were randomized to interdisciplinary team scheduling (n = 55) or conventional scheduling (n = 55). Psychological distress, anxiety, depression, and quality of life were assessed using the Distress Thermometer, Self-Rating Anxiety Scale, Self-Rating Depression Scale, and World Health Organization Quality of Life 100 questionnaire, respectively.

RESULTS

Following the intervention, the interdisciplinary group achieved significantly lower psychological distress [3 (2-3) vs 3 (3-4)], anxiety (41.65 ± 4.29 vs 46.38 ± 4.18), and depression scores (45.79 ± 3.25 vs 50.14 ± 3.69) compared with the control group (all P < 0.05). Quality of life scores also improved significantly in the physical, psychological, and social domains (P < 0.05).

CONCLUSION

The interdisciplinary team scheduling model effectively alleviates psychological symptoms and enhances quality of life among patients with decompensated cirrhosis. This model addresses unmet psychosocial needs through early, continuous, and collaborative care, providing a practical framework for integrating psychological support into chronic liver disease management.

Key Words: Decompensated cirrhosis; Interdisciplinary collaborative team; Nursing scheduling model; Psychological outcome indicators; Patient-centered care; Chronic disease management

Core Tip: This randomized controlled trial evaluated an innovative interdisciplinary team scheduling model integrating physicians, nurses, and psychologists for patients with decompensated cirrhosis. Embedding psychological consultation and narrative nursing into daily clinical routines significantly reduced psychological distress, anxiety, and depression while improving quality of life and patient satisfaction. Compared with conventional medical-nursing scheduling, this model provided earlier and more comprehensive psychological care. The findings highlight the importance of interdisciplinary collaboration in bridging gaps in psychosocial support and offer a novel, practical approach for chronic disease management in cirrhosis.

INTRODUCTION

Decompensated cirrhosis represents a growing global health burden, affecting approximately 2 million adults to 8 million adults in the United States. Its pathophysiological features (e.g., portal hypertension, hepatic encephalopathy) result in frequent hospitalizations, complex clinical management, and substantial psychological strain. The one-year mortality rate reaches 43.8% in patients with two decompensated complications[1]. Psychiatric comorbidities are highly prevalent in this population: Anxiety affects 25%-45%, and depression 29%-72% of cirrhotic patients[2]. These symptoms often exacerbate somatic complaints and further deteriorate quality of life. Hansen et al[3] identified severe distress symptoms including sleep disturbance and pain in this population, while Klankaew et al[4] noted the dual psychological burden of chronic disease stress and cancer-related fear. Importantly, psychological distress has been linked to increased mortality in chronic liver disease patients[5].

Despite this high burden, psychological care for cirrhosis patients remains fragmented and reactive. In most clinical settings, care teams consist of only physicians and nurses; psychological consultation is typically initiated only after overt symptoms emerge, often resulting in delayed and disjointed support. To address this gap, emerging care models advocate embedding psychological support into routine clinical workflows. One such model is the interdisciplinary team scheduling approach, which integrates psychologists into daily care activities to deliver early, proactive, and continuous psychosocial interventions.

The interdisciplinary team scheduling model is based on the biopsychosocial medical theory by Fricchione[6], embedding psychologists into daily schedules and employing narrative nursing techniques to form a closed-loop intervention chain, optimizing team collaboration (physicians, nurses, psychotherapists) to fill existing gaps. This model emphasizes: Standardized management of physiological symptoms; early psychological intervention; and personalized allocation of social support. Its core lies in enhancing patients’ self-efficacy through interdisciplinary collaboration, thereby improving self-management behaviors. Scriney et al[7] in a systematic review, confirmed that prehabilitation psychological rehabilitation interventions can alleviate anxiety in cancer patients. Prehabilitation is a relatively novel intervention aimed at preparing individuals from diagnosis onward for treatment-related stress. Narrative therapy was chosen as our psychological support method because medical practice endowed with narrative capability is regarded as the optimal model of humane and effective care, crucial throughout the chronic disease journey[8]. Hu et al[9] posits that it has a significant impact on depressive symptoms in adults with somatic illness.

This study aimed to construct a “physiological-psychological-narrative” triadic intervention model and evaluate its clinical effects in patients with decompensated cirrhosis. Specifically, we conducted a randomized controlled trial to assess whether this interdisciplinary team scheduling model improves psychological distress, anxiety, depression, and quality of life, compared to conventional physician-nurse scheduling. We hypothesized that embedding narrative-based psychological support into routine care would yield superior patient-reported outcomes and offer a scalable solution for psychosocial integration in chronic disease management.

MATERIALS AND METHODS

Study design

The purpose of this intervention was to improve self-management and self-efficacy in patients with decompensated cirrhosis through a randomized, single-blind, single-center trial. From January 2022 to December 2024, 110 inpatients with decompensated cirrhosis and Distress Thermometer (DT) score ≥ 4 admitted to the gastroenterology department of a tertiary hospital in Guangxi Zhuang Autonomous Region were recruited.

Randomization was performed using a random number table by an independent statistician uninvolved in-patient care or outcome assessment. Two associate chief nurses, responsible for pre-intervention and post-intervention evaluations, were blinded to group assignments. Given the nature of the intervention, patients and care providers were not blinded; however, patients were unaware of the expected benefits of either model to reduce expectancy bias. A total of 55 patients were assigned to the interdisciplinary team scheduling group and 55 to the conventional scheduling (control) group.

Characteristics of participants

This study enrolled patients with decompensated cirrhosis who met all of the following inclusion criteria: (1) Age ≥ 18 years; (2) Diagnosis of decompensated cirrhosis according to the cirrhosis diagnostic criteria proposed in the 13^th edition of Practical Internal Medicine[10]; and (3) Consent to participate in this study. Exclusion criteria were: (1) Patients with language communication disorders; (2) Patients with cognitive impairment; (3) Expected survival < 3 months; and (4) History of prior systematic psychological intervention. This study was approved by the Ethics Committee of Red Cross Hospital of Yulin City (Approval No. 2021-K001-01). All patients provided informed consent after understanding the study procedures.

Sample size calculation

Sample size was calculated using G*Power 3.1. Based on literature, the effect size was set at 0.77, α = 0.05, and power = 0.90, yielding a minimum of 36 patients per group. Allowing for a 20% dropout rate, a total of 110 patients (55 in the intervention group and 55 in the control group) were planned for inclusion. A random number generator was used to produce random numbers in a 1:1 ratio. Participants with odd random numbers were allocated to group A, and those with even random numbers to group B; the specific assignment was concealed from the corresponding author (group A designated as the intervention group, group B as the control group).

Theoretical framework

This study is grounded in the biopsychosocial medical model, integrating narrative medicine and prehabilitation psychological interventions to construct a “physiological-psychological-narrative” closed-loop intervention chain[11]. Patients with decompensated cirrhosis commonly experience high rates of anxiety, depression, and a dual psychological burden of “chronic stress-acute fear”, necessitating multidimensional interventions. Through interdisciplinary collaboration (physicians, nurses, psychologists), physiological management is optimized and psychologists are embedded into routine scheduling to enable early psychological intervention. Narrative therapy is employed to guide patients in reconstructing illness perceptions[12], thereby alleviating depressive symptoms; concurrently, prehabilitation interventions enhance patients’ coping abilities for treatment-related stress, breaking the “psychological distress-somatic deterioration” cycle. Under this theoretical framework, the closed-loop intervention chain aims to strengthen patients perceived control over symptoms, improve self-management and quality of life, provide a theoretical basis for chronic disease management, reduce medical burden, and enhance survival outcomes.

Intervention

Establishment of a triadic medical-nursing-psychological scheduling management team: A dedicated interdisciplinary team was formed, comprising: 2 associate chief physicians, 3 attending physicians, 1 nationally certified level-2 psychological counselor, 1 chief nurse (head nurse), 2 associate chief nurses, 3 charge nurses, and 3 staff nurses. Physicians were responsible for diagnosis and medical treatment. The psychological counselor provided personalized psychological consultation and care addressing patients’ distress factors. Two associate chief nurses, after training, were responsible for assessing psychological distress, anxiety, depression, and quality of life in patients with decompensated cirrhosis; they did not participate directly in treatment or psychological nursing. Six charge nurses and staff nurses were responsible for routine treatment care and general psychological support.

The psychological counselor received 9 hours of structured face-to-face training (three 3-hour sessions) conducted by two senior faculty members specializing in narrative nursing and psychosocial care. The training was based on the narrative therapy framework proposed by White and Epston and included detailed instruction on the five core techniques: Externalization, deconstruction, re-authoring, external witnesses, and therapeutic documents. Each session combined didactic teaching with case-based discussions, role-playing, and supervised simulations to ensure skill acquisition and consistency. To monitor adherence to the intervention protocol, the counselor completed a standardized intervention log after each session, documenting the duration, content, techniques applied, and patient response. The research team held weekly supervision meetings to review counseling records, address any implementation deviations, and maintain fidelity to the intervention framework. Any inconsistencies were discussed and corrected under the guidance of the principal investigator.

Intervention group - implementation of the triadic medical-nursing-psychological scheduling model: On the basis of the original medical-nursing scheduling, from Monday to Friday during daytime an additional psychological consultation shift was added. At 8:00 each morning, the handover meeting was conducted jointly by physicians, nurses, and the psychological counselor. Night-shift nurses and physicians conducted handover as per routine; upon completion, the psychological counselor reported on the psychological status and points of attention for patients with DT score ≥ 4. After the full handover, physicians and nurses, based on the special patients’ psychological status and guidance provided by the psychological counselor, gave those patients extra attention and communication, working together with the psychological counselor to alleviate patients’ psychological distress. An associate chief nurse was responsible for assessing newly admitted patients with decompensated cirrhosis (diagnosed by the specialty physician) for psychological distress, anxiety/depression, and quality of life; for patients with DT score ≥ 4, the results were given to a statistician not on the research team for randomization using a random table. Patients allocated to the experimental group by the statistician were handed over to the psychological counselor, who, according to job responsibilities and plan, conducted assessments and delivered individualized narrative nursing psychological interventions. Except for patients in severe condition who could not walk - who were assessed and intervened with in their wards - all other patients went to the psychological consultation room. Forward-based assessment and intervention, it was required that no one else be present in the ward, to protect patient privacy, allow the patient to speak freely about personal life details, ensure assessment accuracy, and maximize intervention effectiveness. Individualized psychological interventions occurred twice weekly, each session lasting 1.5-2.0 hours, continuing until discharge. After assessment and intervention, the psychological counselor made and preserved detailed records; before the end of shift, the counselor handed over to the on-duty physicians and nurses, reporting the psychological status and points of attention for special patients, and recorded these in the special patients’ psychological-status logbook, which was kept in the nurses’ office for reference. The counselor did not work on Saturdays or Sundays; during those days, physicians and nurses reviewed the special patients’ psychological-status logbook and provided appropriate psychological care. Before discharge, an associate chief nurse reassessed patients for psychological distress, anxiety, and depression. One month after discharge, follow-up was conducted and patients’ quality of life was scored.

Narrative nursing methods

Externalization: Separate the person from the disease, enabling the patient to focus on the disease or problem and increasing their sense of control over it. For example, for a patient “Guan” with cirrhosis complicated by hepatocellular carcinoma, based on the psychological state “fear of death” at that time, the issue was named “fear of death”, thereby separating patient Guan from the disease. Concurrently, this shifts healthcare providers’ focus from the disease and nursing tasks to the patient as an individual.

Deconstruction: Explore the sociocultural context underlying the problem or behavior. For example, if patient Guan is repeatedly readmitted because family cultural attitudes have shaped him to feel useless and near death, this understanding helps explain seemingly irrational behaviors.

Re-authoring: Based on the omitted fragments and exceptions identified through the “externalizing conversation”, alter the storyline. For instance, identify the “exception” that patient Guan accompanies and educates his daughter, who is a top student in a key high school class; praise and affirm his contribution to his daughter, guiding him to continue accompanying and educating her, forming a new narrative strand in which his daughter is admitted to a good university.

External witnesses: Use others’ “perspectives” and “statements” to strengthen the patient’s empowerment. For example, presenting patient Guan with a certificate of recognition in the presence of all medical staff makes the department’s entire staff serve as external witnesses, making the change real and reinforcing the behavior.

Therapeutic documents: Use artifacts to reinforce beliefs and achieve genuine therapeutic effect. For instance, the certificate awarded to patient Guan can serve as a therapeutic document, helping him continuously reinforce the belief that he has control over his own destiny.

In summary, narrative nursing methods, through multidimensional operations, aim to help patients re-examine and resolve life issues (Simone[8]), enhance self-identity and coping ability for disease, and promote recovery and psychological health.

Control group intervention method

Two trained associate chief nurses specifically assessed newly admitted patients with decompensated cirrhosis (diagnosed by the specialty physician) for psychological distress, anxiety/depression, and quality of life; for patients with psychological distress score ≥ 4, results were given to a statistician not on the research team for randomization using a random table. Patients allocated to the control group were reported by the statistician to the attending physician and charge nurse. The attending physician and charge nurse provided the routine treatment plan and nursing care for decompensated cirrhosis, and addressed factors related to patients’ psychological distress by offering comfort and encouragement. If physicians or nurses identified any of the following conditions, this triggered a psychological consultation: Hospital Anxiety and Depression Scale ≥ 60; poor treatment adherence (e.g., refusal to take medication); or patient-initiated request for psychological support. Consultation process: The psychological counselor completed a single assessment and intervention within 48 hours; fixed follow-up was conducted, recording only the consultation content. Before discharge, patients were reassessed for psychological distress, anxiety, and depression; one month after discharge, follow-up was conducted and patients’ quality of life was scored and recorded.

Quality control

Inclusion and exclusion criteria were strictly followed to minimize selection bias and ensure data comparability among study subjects. A database was established in Excel using double-entry: All data were entered in pairs and consistency checked. Any inconsistent entries were verified until 100% consistency was achieved.

General information

A questionnaire designed by the research team was used to collect patients’ demographic and clinical characteristics, including sex, age, marital status, type of insurance coverage, and Child-Pugh score for liver function. Clinical factors included cirrhosis duration, presence of pain, and sleep disturbances, which were assessed based on patient self-report at admission. The selection of these variables was informed by a prior cross-sectional survey conducted by the authors involving 300 patients with decompensated cirrhosis. That study identified marital status, economic burden, method of healthcare payment, disease duration, pain, and sleep problems as key contributors to psychological distress in this population. Accordingly, these variables were incorporated into the baseline comparison of general information between groups in the present study.

DT

DT serves as a rapid screening tool for identifying psychological distress. We used the Chinese version of the DT[13]. The reliability and validity of this scale have been verified in multiple countries and regions, with a diagnostic cutoff ≥ 4 points[14]. The DT comprises two parts: (1) The DT scale, ranging from 0 (no distress) to 10 (extreme distress) on an 11-point scale, instructing patients to mark their experienced distress level over the past week; and (2) A problem checklist of 39 items covering five domains: Practical problems, family problems, emotional problems, physical problems, and spiritual/religious concerns. Participating patients respond “yes” or “no” to each of the 39 specific items; the spiritual/religious domain contains no specific items. Scores of 1-3 indicate mild distress, 4-6 moderate distress, 7-9 severe distress, and 10 extreme distress. At the cutoff of 4 points, sensitivity and specificity are 0.80 and 0.70, respectively.

Self-rating anxiety and depression scales

Anxiety and depression were assessed using the Self-Rating Anxiety Scale and Self-Rating Depression Scale[15]. These scales comprehensively, accurately, and rapidly reflect the respondent’s anxiety and depression symptoms, severity, and subsequent changes. Scores below 50 are considered within the normal range; scores of 50-59 indicate mild anxiety or depression; 60-69 indicate moderate anxiety or depression; and scores ≥ 70 indicate severe anxiety or depression. The Cronbach’s alpha reliability coefficient for these scales’ ranges from 0.80 to 0.90.

Quality of life measurement scale

Quality of life was measured using the World Health Organization Quality of Life 100 (WHOQOL-100) questionnaire scale (Skevington et al[16]). This instrument has been applied in China among the general population and patients with chronic diseases; the Chinese version demonstrates good reliability and validity. The scale comprises six domains - physical, psychological, independence, social relationships, environment, and spirituality/religion/personal beliefs - encompassing 24 facets, plus one item evaluating overall health status and overall quality of life. The total score ranges up to 100 points, with higher scores indicating better quality of life.

Caring nursing work satisfaction

Patient satisfaction with caring nursing practices was evaluated using the caring nursing work satisfaction questionnaire revised by Jiang et al[17]. The instrument contains 30 nursing behavior items, each rated on a five-point scale from 5 to 1, representing “very satisfied”, “satisfied”, “neutral”, “dissatisfied”, and “very dissatisfied”, respectively. Content validity index assessed by peer experts is 0.82, and the questionnaire’s reliability coefficient is 0.85. Higher scores denote greater patient satisfaction.

Environment preparation

A dedicated, independent psychological consultation room was prepared according to design requirements for counseling spaces[18]. The room is quiet and soundproof, with suitable lighting and harmonious color tones, primarily light blue, light yellow, and light green. Furnishings include a desk with a computer, a filing cabinet, two chairs, and a sofa. The overall environment aims to make patients feel warm, welcoming, and relaxed.

Establishment of psychological consultation shift responsibilities and workflow

The psychological consultation shift is executed by a counselor holding a national level-2 psychological counselor certificate with rich clinical counseling experience. Working hours are Monday to Friday, 08:00 to 17:30. At 08:00 each morning, the counselor participates in the handover meeting with physicians and nurses. Subsequently, for patients with DT score ≥ 4 admitted to the intervention group, personalized psychological interventions are provided based on assessment results and the DT problem checklist, primarily employing narrative nursing methods. Narrative nursing has been demonstrated to facilitate emotional regulation in oncology patients[19]. Its five core techniques are externalization, deconstruction, re-authoring, external witnesses, and therapeutic documents.

Data collection methods

From January 2022 to December 2024, for all patients in both the intervention and control groups, pre-intervention and post-intervention assessments of psychological distress, anxiety/depression scores, and quality of life scores were collected by two associate chief nurses blinded to group allocation. Data were cross-checked by two individuals to ensure completeness and accuracy of recorded information (Figure 1).

Figure 1 Data collection procedure flowchart.

Statistical analysis

Data were entered into SPSS version 17.0 statistical software, with double verification of entries. Continuous variables conforming to a normal distribution were expressed as mean ± SD and analyzed using independent-samples t-tests; non-normally distributed continuous variables were expressed as median (P25-P75) and analyzed using nonparametric tests; categorical variables were described by n (%) and analyzed using χ² tests. A two-sided P < 0.05 was considered statistically significant.

RESULTS

Baseline characteristics

Initially, 55 patients were enrolled in each group. During the study, 10 patients were lost to follow-up (5 in the intervention group and 5 in the control group), yielding a loss rate of 9.09%. Ultimately, 50 patients in the experimental group and 50 patients in the control group completed the study. There were no statistically significant differences in demographic characteristics between the two groups (P > 0.05), indicating comparability (Table 1).

Table 1 Comparison of baseline characteristics between the intervention and control groups, n (%)/mean ± SD.

Variable	Intervention group (n = 50)	Control group (n = 50)	Test statistic	P value
Sex			χ2 = 1.190	0.275
Male	40 (80.00)	44 (88.00)
Female	10 (20.00)	6 (12.00)
Age (years)	51.62 ± 9.17	54.98 ± 8.76	t = -1.864	0.065
Liver function grade (Child-Pugh score)			Z = -0.157	0.875
Grade A	11 (22.00)	13 (26.00)
Grade B	29 (58.00)	26 (52.00)
Grade C	10 (20.00)	11 (22.00)
Marital status			χ2 = 0.332	0.564
Married	42 (84.00)	44 (88.00)
Widowed/divorced	8 (16.00)	6 (12.00)
Medical payment method			Z = -0.923	0.356
Urban medical insurance	8 (16.00)	12 (24.00)
Rural medical insurance	36 (72.00)	33 (66.00)
Self-pay	6 (12.00)	5 (10.00)
Duration of cirrhosis (years)	8.32 ± 3.43	8.34 ± 3.37	t = -0.029	0.977
Presence of pain			χ2 = 0.367	0.545
Yes	30 (60.00)	27 (54.00)
No	20 (40.00)	23 (46.00)
Presence of sleep problems			χ2 = 0.407	0.523
Yes	35 (70.00)	32 (64.00)
No	15 (30.00)	18 (36.00)

Main outcomes

Comparison of psychological distress, anxiety, and depression scores between groups: At baseline (upon admission), there were no statistically significant differences between the intervention and control groups in DT scores, Self-Rating Anxiety Scale scores, or Self-Rating Depression Scale scores (P > 0.05). After the intervention, the intervention group demonstrated significantly greater improvements in distress, anxiety, and depression scores compared with the control group (P < 0.05; Table 2).

Table 2 Comparison of psychological distress, anxiety, and depression scores between groups, median (interquartile range)/mean ± SD.

Group	n	Psychological distress score		Anxiety score		Depression score
		Pre-intervention	Post-intervention	Pre-intervention	Post-intervention	Pre-intervention	Post-intervention
Intervention	50	4 (4-5)	3 (2-3)	47.95 ± 5.33	41.65 ± 4.29	53.96 ± 4.82	45.79 ± 3.25
Control	50	4 (4-5)	3 (3-4)	48.54 ± 4.23	46.38 ± 4.18	53.32 ± 4.47	50.14 ± 3.69
Z/t		Z = -0.807	Z = -5.771	t = -0.618	t = -5.583	t = 0.677	t = -6.25
P value		0.420	0.000	0.538	0.000	0.500	0.000

Comparison of quality of life scores pre-intervention and post-intervention: Before the intervention, there was no statistically significant difference in WHOQOL-100 quality of life scores between the two groups (P > 0.05). Following the intervention, the intervention group showed significantly higher quality of life scores than the control group (P < 0.05; Table 3).

Table 3 Pre-intervention and post-intervention quality of life comparison between two patient groups, mean ± SD/median (interquartile range).

Group (n = 5)	Physiological domain		Psychological domain		Independence domain		Social relationships domain		Environment domain		Spiritual support/religion/personal belief		Overall quality of life score
	Pre-intervention	Post-intervention	Pre-intervention	Post-intervention	Pre-intervention	Post-intervention	Pre-intervention	Post-intervention	Pre-intervention	Post-intervention	Pre-intervention	Post-intervention	Pre-intervention	Post-intervention
Experimental group	11.27 ± 1.65	14.40 ± 1.17	12.16 ± 1.52	14.57 ± 1.09	11.77 ± 1.59	14.08 ± 0.89	12.56 ± 1.05	13.15 ± 1.36	12.98 ± 1.37	13.34 ± 1.13	12 (12-13)	13 (12-14)	10 (10-12)	12 (12-13)
Control group	11.49 ± 1.43	12.37 ± 1.20	12.41 ± 1.19	13.05 ± 1.45	11.71 ± 1.61	12.11 ± 1.64	12.11 ± 1.29	12.25 ± 1.29	13.03 ± 0.97	13.13 ± 1.05	12 (11-13)	12 (11-13)	10 (9-12)	10 (10-12)
Z/t	t = -0.711	t = 8.559	t = -0.912	t = 5.908	t = 0.191	t = 7.495	t = 0.968	t = 3.397	t = -0.249	t = 0.990	Z = -0.813	Z = -2.744	Z = -0.443	Z = -6.330
P value	0.479	0	0.364	0	0.849	0	0.337	0.001	0.804	0.325	0.416	0.006	0.658	0

Comparison of caring nursing work satisfaction between groups: At baseline, there was no statistically significant difference in caring nursing work satisfaction scores between the intervention and control groups (P > 0.05). After the intervention, patient satisfaction with caring nursing practices was significantly higher in the intervention group compared with the control group (P < 0.05; Table 4).

Table 4 Comparison of satisfaction scores for care nursing between two groups of patients, mean ± SD.

Group	Sample size	Pre-intervention	Post-intervention
Experimental group	50	112.90 ± 6.24	144.28 ± 4.43
Control group	50	113.50 ± 7.26	125.78 ± 8.39
t value		-0.44	14.23
P value		0.66	0.001

DISCUSSION

This study was a randomized controlled trial designed to evaluate the clinical effects of an interdisciplinary team scheduling model on improving the psychological distress index, alleviating anxiety and depressive symptoms, and enhancing quality of life in patients with decompensated cirrhosis. Our results support the validity of both hypotheses: That the interdisciplinary team scheduling model is an effective intervention to improve patients’ psychological distress index, relieve anxiety and depression symptoms, and enhance quality of life, with efficacy surpassing that of the traditional medical-nursing scheduling model. Overall, these findings underscore the clinical significance and robustness of this intervention.

Our findings align closely with prior literature. Zhang et al[20] demonstrated that patients with decompensated cirrhosis endure substantial psychological distress and a marked decline in quality of life; they emphasized that beyond monitoring clinical indicators, providing psychological support early in the disease course is key to improving disease-related quality of life. In our study, by integrating psychological intervention with medical and nursing care through an interdisciplinary scheduling model, we effectively alleviated patients’ anxiety and depression, consistent with Scriney et al[7] who concluded that “early psychological support is critical for improving quality of life”. Furthermore, Chukwuemeka et al[21], using structural equation modeling, confirmed that psychological distress positively predicts suicidal ideation; our study further validates the necessity of structured psychological interventions (e.g., dynamic assessment and counseling by a psychologist) in reducing such risks. It is notable that Ma et al[22] found that postoperative psychological distress in cancer patients correlates moderately and positively with the need for humanistic nursing care; our model, by reinforcing collaboration among medical, nursing, and psychological professionals, directly addressed patients’ psychological needs and reduced feelings of helplessness. However, in our study, no significant improvement was observed in the environmental domain, which is consistent with the findings by Wang et al[23]. This domain includes aspects such as financial resources, living environment, physical safety, and access to social and health services - factors that are largely shaped by external socioeconomic conditions and thus beyond the scope of an inpatient psychological intervention. As noted by Zou et al[24], quality of life in Chinese patients with hepatocellular carcinoma is often constrained by limited social support and environmental stressors. This suggests that while interdisciplinary scheduling models can improve psychological and interpersonal domains, addressing environmental quality of life may require broader system-level support. Future implementations could consider linking hospital-based interventions with community services, family involvement, or social work resources to fill this gap more effectively.

The effects of the interdisciplinary scheduling model can be attributed to the synergistic action of multidimensional strategies. First, team collaboration enabled dynamic integration of psychological intervention with the medical process. Zhang et al[25] demonstrated that humane nursing significantly improved nutritional status and psychological stress in colorectal cancer patients; similarly, in our model the psychological counselor adjusted counseling approaches according to the treatment stage (e.g., for patients reluctant to face their disease, counseling modified their attitude, and, with family and staff witness, certificates were awarded to reinforce positive behavior), reflecting a parallel logic. Second, the application of narrative nursing and positive psychological priming enhanced patients’ sense of control over their illness. Zhu et al[26] showed that strength-based narrative therapy can improve depressive symptoms and quality of life in older adults; our study likewise found that, through the “person is not the disease” narrative framework, patients progressively rebuilt confidence in life, with significant improvements in the independence and social relationship domains of quality of life. Finally, flexible scheduling ensured continuity of support. In traditional scheduling models, information gaps can delay psychological assessment (e.g., failure to identify patient anxiety promptly), whereas our model’s seamless coordination among medical, nursing, and psychological staff prevented this issue, consistent with Zhang et al[20] advocating for “continuous psychological support”. These strategies not only alleviated psychological distress in the short term but may also drive long-term improvements in quality of life by enhancing treatment adherence and fostering a positive attitude toward life.

This study offers three practical implications for clinical nursing. First, it is essential to promote the interdisciplinary scheduling model. Zou et al[24] emphasized that quality of life in liver disease patients is affected by both physical and psychological burdens; our model’s multidisciplinary collaboration (e.g., physician-nurse-psychologist team) delivers comprehensive support, aligning closely with Zhang et al[20] recommendation to “integrate medical and psychological resources”. Second, strengthening training in psychological intervention skills for healthcare staff is necessary. Ma et al[22] noted that humanistic nursing care needs closely relate to psychological distress; in our model, nurses employed narrative nursing techniques (e.g., preparing patients through pre-treatment disease information) to effectively alleviate patient fear, suggesting these skills should be incorporated into routine training. Third, a dynamic psychological assessment mechanism should be established. Chukwuemeka et al[21] showed that psychological distress is dynamic; our model’s psychologist conducted regular weekly assessments (systematic screening Monday to Friday), ensuring timeliness and personalization of interventions. Additionally, health education grounded in self-efficacy theory (e.g., using successful case examples to boost patient confidence) can serve as an effective supplement to the three-in-one model, resonating with Zhang et al’s view[25] that “humane nursing must align with individualized patient needs”, further optimizing patient treatment experience and health outcomes.

This study has several limitations. The sample size is relatively small and drawn from a single institution, which may affect the generalizability of results. Additionally, the single-center design may introduce potential selection bias, as the enrolled patients may not fully represent the broader population of individuals with decompensated cirrhosis. Moreover, the intervention period was relatively short, precluding assessment of long-term effects. Although improvements in psychological distress, anxiety, and depression were observed one month post-discharge, the long-term sustainability of these effects remains uncertain, especially given the chronic and progressive nature of cirrhosis. Extended follow-up is warranted to evaluate durability over time. The lack of significant improvement in the environmental domain also indicates a need to explore more comprehensive intervention strategies. Future research could expand sample size, extend follow-up duration, and incorporate environmental intervention measures to further validate and refine this model.

CONCLUSION

Our findings suggest that an interdisciplinary team scheduling model is an effective intervention to improve psychological distress index, alleviate anxiety and depressive symptoms, and enhance quality of life in patients with decompensated cirrhosis, outperforming the traditional medical-nursing scheduling model. This provides a theoretical basis and practical direction for clinical nursing. Future efforts should integrate multidimensional intervention strategies to promote comprehensive improvements in patients’ physical and mental health.