Stage-Specific Interventions Based on Timing It Right Theory and Trajectory Analysis Alleviate Burden and Stress of Caregivers for Patients with Decompensated Cirrhosis

Stage-Specific Interventions Based on Timing It Right Theory and Trajectory Analysis Alleviate Burden and Stress of Caregivers for Patients with Decompensated Cirrhosis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Stage-Specific Interventions Based on Timing It Right Theory and Trajectory Analysis Alleviate Burden and Stress of Caregivers for Patients with Decompensated Cirrhosis Xin-yu Fu, Si-yan Yan, Jia-wei Liang, Liu-yi jia, Ya-qi Song, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7223943/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Purpose This study aimed to develop targeted interventions for caregivers of patients with decompensated cirrhosis, guided by the Timing It Right (TIR) model, to assess the impact on caregiving ability, burden, and quality of life across care stages. Method A total of 110 caregivers were recruited and randomly assigned to either a control group receiving routine health education or an intervention group receiving TIR-based interventions. Caregiving ability, burden, and quality of life were assessed at baseline, discharge, and at 3 and 6 months post-discharge. Trajectory analysis was applied to visualize intervention effects. Results Of 102 participants completing the study, caregivers in the intervention group demonstrated significantly lower caregiving burden and higher quality of life at both 3 and 6 months post-discharge compared to controls (P < 0.05). Trajectory analysis suggested the interventions effectively reduced psychological burden, although some caregivers showed rebound effects, indicating a need for sustained support. Conclusions TIR-based interventions tailored to caregiving stages enhance caregiver ability, reduce burden, and improve quality of life. These findings suggest that integrating stage-specific support for caregivers in clinical settings can better address their evolving needs, positively impacting patient outcomes. Regular reinforcement of interventions is recommended to maintain these benefits over time. Implications for Clinical Practice: Implementing stage-specific interventions for caregivers can provide crucial support and relief, enabling better patient care and caregiver resilience. Tailoring interventions based on trajectory feedback further optimizes the timing and long-term effectiveness of caregiver support strategies. Timing It Right model Caregiver Intervene Trajectory analysis Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Liver cirrhosis is a chronic, progressive, and diffuse liver injury, representing the end stage of various chronic liver diseases. It poses a growing public health challenge not only in China but also globally[ 1 – 4 ]. The complications associated with cirrhosis are severe and life-threatening, contributing significantly to global mortality rates among adults[ 5 , 6 ]. By 2025, it is projected that 40% of chronic liver disease cases in China will be attributed to cirrhosis, highlighting the urgent need for care and support for both patients and their caregivers. Patients in the decompensated stage of cirrhosis often experience complications such as ascites, hypersplenism, gastrointestinal bleeding, infections, and liver failure[ 7 ]. Managing these conditions requires close cooperation between healthcare professionals and family caregivers. In China, family caregivers play a crucial role in providing daily care, financial support, and emotional assistance. However, they also bear significant stress and burden[ 8 ]. Their responsibilities include managing the patient’s daily activities, monitoring disease symptoms, ensuring medication adherence, and providing emotional support[ 9 ]. Unfortunately, caregivers often lack the necessary training and support, leading to their own mental and physical strain, which can make them "hidden patients" themselves[ 10 – 12 ]. The Timing It Right (TIR) model, developed by Cameron, was originally designed to address the evolving needs of caregivers for stroke patients, emphasizing that caregivers’ requirements change throughout different stages of the disease[ 13 ]. This model has been successfully applied to various chronic diseases, showing significant improvements in caregiver well-being and patient outcomes. It has been used internationally for critically ill patients[ 14 ], stroke[ 15 – 18 ], and acute respiratory distress syndrome[ 19 ], helping caregivers cope better and facilitating patients' reintegration into family and society. In the context of caring for patients with decompensated liver cirrhosis, the TIR model is equally applicable, as caregivers' experiences and needs vary across different stages and evolve over time. Healthcare professionals should recognize these dynamic changes and provide tailored support and education to help caregivers adapt, enhance their caregiving abilities, reduce their burden, and ultimately promote patient health. The latent class trajectory model takes individual differences into account and groups similar individuals based on dynamic changes in their trajectories[ 20 , 21 ]. This allows healthcare providers to offer more targeted support and education to different populations, optimizing interventions. This study, based on the TIR model, aims to explore the specific needs of caregivers of patients with decompensated liver cirrhosis at various stages of care and develop corresponding interventions. Through trajectory-based grouping, the study will further analyze and refine the interventions. The goal is to establish a stage-specific intervention program for caregivers based on the TIR model, validate its effectiveness, and ultimately enhance caregivers’ skills, reduce their burden, and improve their quality of life. Additionally, by using trajectory feedback, the study will clarify how these interventions achieve their effects. This research aims to provide a theoretical foundation for caregiver interventions in decompensated liver cirrhosis and offer a basis for extending liver cirrhosis care into family and community settings. Methodology Patients From November 2020 to April 2021, patients with decompensated liver cirrhosis and their caregivers were recruited, with caregivers serving as the focus of this study. The inclusion and exclusion criteria for patients and caregivers are as follows: Inclusion criteria for patients: 1. Diagnosed with decompensated liver cirrhosis according to the 2019 "Guidelines for the Diagnosis and Treatment of Liver Cirrhosis."[22] 2. Aged between 18 and 70 years. 3. No history of psychiatric disorders or cognitive impairments, with full cognitive and functional abilities to independently complete questionnaires. 4. Provided informed consent and voluntarily participated in the study. Exclusion criteria for patients: 1. Severe psychiatric illness or a family history of psychiatric disorders. 2. Concurrent hepatic encephalopathy, liver cancer, or severe heart or lung disease, making participation difficult. 3. Cognitive impairment or intellectual disability, rendering them unable to understand or complete questionnaires. Inclusion criteria for caregivers: 1. Primary caregivers responsible for patient care during hospitalization and continuing care after discharge (if multiple caregivers are involved, the one with the longest caregiving time or the patient-designated caregiver was chosen). 2. Aged between 18 and 70 years. 3. No psychiatric disorders, with normal reading and communication abilities. 4. Provided informed consent and voluntarily participated in the study. 5. Provided at least four hours of care daily. Exclusion criteria for caregivers: 1. Cognitive or communication impairments or emotional instability. 2. Unable to complete questionnaires. 3. Paid caregivers such as volunteers or hired personnel. 4. Serious personal illness. Withdrawal criteria: 1. Patient's condition worsens or becomes critical during the study, resulting in discontinuation. 2. The patient or caregiver withdraws voluntarily for personal reasons during the study. Randomization Patients and caregivers were randomly assigned to either a control group or an intervention group using a computerized randomization method. A non-intervention team member managed group assignment and allocation concealment. During the study, the same physicians and nurses in the two wards were retained, and the wards had identical environments, with comparable staff numbers, educational backgrounds, and professional titles. The control group received standard health education and follow-up care, while the intervention group received additional interventions based on the TIR model. Data Collection General Data: 1. Patient information: gender, age, education level, employment status, marital status, time since cirrhosis diagnosis, knowledge of liver cirrhosis, type of medical insurance, and Child-Pugh classification of liver function. 2. Caregiver information: gender, age, education level, marital status, relationship to the patient, household monthly income, daily caregiving hours, presence of additional caregivers, and employment status. Questionnaire Data: Within 48 hours of patient admission, the study team explained the research purpose, significance, and questionnaire instructions to eligible patients and caregivers, obtaining informed consent. Questionnaires were used to assess caregiving ability, burden, and quality of life. These were administered at admission, discharge, and three and six months after discharge. For participants with reading or vision impairments, the researcher assisted in completing the questionnaires. Data were collected through hospital visits, telephone follow-ups, or home visits, ensuring the accuracy and completeness of responses. The three questionnaires used were the Family Caregiver Task Inventory (FCTI)[23, 24], the Zarit Caregiver Burden Interview (ZBI)[25, 26], and the 36-item Short Form Health Survey (SF-36)[27-29]. FCTI scores indicate caregiving difficulty and lower caregiving ability with higher scores. Higher ZBI scores reflect a greater caregiver burden, while higher SF-36 scores indicate a better quality of life[30]. Detailed information on the questionnaires can be found in the supplementary materials. Interventions The control group received standard digestive department health education, including admission education, health guidance, discharge planning, and post-discharge follow-up. The intervention group received additional stage-based interventions guided by the TIR model. The design process for the TIR-based intervention plan is detailed in the supplementary materials 1. Figure 1 shows the entire experimental process. Data Analysis After double-checking the data, R language and the "lcmm" package were used for data processing and analysis to determine the best trajectory grouping. SPSS 26.0 software was used for descriptive statistical analysis of demographic data, with age, gender, and education level presented as means and standard deviations or percentages. Normally distributed data were described with means and standard deviations, while non-normally distributed data were analyzed using the Mann-Whitney U test and described with medians and interquartile ranges. Two-sample t-tests and repeated measures analysis of variance were employed to compare differences between the two groups at various time points, assessing the intervention's effectiveness. A significance level of α = 0.05 was applied, with P-values less than 0.05 considered statistically significant. Results Based on the formula for comparing two sample means, the required sample size for each group was calculated to be 44. To account for a potential 20% dropout rate, the final sample size was determined to be 55 participants per group, totaling 110 participants. These participants were then divided into the intervention and control groups, with 55 participants in each. By the end of the study, 51 valid samples were collected from each group. In the control group, four participants were lost to follow-up: two patients died due to worsening conditions, one caregiver was unreachable due to a change in phone number, and one caregiver was replaced. In the intervention group, four participants were also lost: one patient was cared for by a hired caregiver after discharge, one patient died, and two caregivers withdrew due to personal health issues. The overall dropout rate was 7.27%. Baseline Characteristics The majority of the patients were male (73.5%) with a mean age of 54.92 ± 8.78 years. Most had a low level of education, with 34.3% having a middle school education and 30.4% having only primary education or less. Many were farmers (56.9%), and 91.2% were married. There were no statistically significant differences between the two groups in terms of gender, age, education level, occupation, marital status, time since liver cirrhosis diagnosis, knowledge of liver cirrhosis, type of medical insurance, or Child-Pugh classification (P > 0.05), making the groups comparable (see Table 1 for details). Table 1 Baseline characteristics of patients between control group and intervention group Characteristic Number (%) Intervention group(n = 51) Number(%) Control group(n = 51)Number༈%༉ P value Gender 0.501 Male 75(73.5) 39(76.5) 36(70.6) Female 27(26.5) 12(23.5) 15(29.4) Age 54.92 ± 8.78 54.39 ± 8.81 55.45 ± 8.82 0.545 Education level 0.756 Primary school and below 31(30.4) 17(33.3) 14(27.5) Junior high school 35(34.3) 15(29.4) 20(39.2) Senior high school / Vocational college 14(13.7) 7(13.7) 7(13.7) Undergraduate and above 22(21.6) 12(23.6) 10(19.6) Work status 0.930 Farmer 58(56.9) 28(54.9) 30(58.8) Unemployed 18(17.6) 10(19.6) 8(15.7) Retire 15(14.7) 8(15.7) 7(13.7) Other 11(10.8) 5(9.8) 6(11.8) Marriage 0.485 Married 93(91.2) 45(88.2) 48(94.1) Unmarried 9(8.8) 6(11.8) 3(5.9) Time of detecting liver cirrhosis 10 years 14(13.7) 6(11.8) 8(15.7) Understanding of liver cirrhosis 0.993 Very familiar 12(11.8) 6(11.8) 6(11.8) Fairly familiar 17(16.6) 8(15.7) 9(17.6) Moderately familiar 36(35.3) 18(35.3) 18(35.3) Not familiar 37(36.3) 19(37.2) 18(35.3) Types of medical expenses 0.848 Government-funded healthcare 16(15.7) 9(17.6) 7(13.7) New rural cooperative medical scheme 71(69.6) 35(68.7) 36(70.6) Medical insurance 15(14.7) 7(13.7) 8(15.7) Child-Pugh grade 0.426 Class B 46(45.1) 25(49) 21(41.2) Class C 56(54.9) 26(51) 30(58.8) Among caregivers, the majority were female (69.6%) with a mean age of 51.60 ± 8.49 years. Most caregivers had low educational levels, with 52.9% having primary education or less, and 92.2% were married. The majority of caregivers were the patients’ spouses (71.6%). Approximately 44.1% of caregivers reported a household monthly income below 1000 RMB, and 41.2% provided 4–12 hours of care per day. Most caregivers (86.3%) were the sole providers of care, with only 13.7% having additional caregivers. Additionally, 58.8% of caregivers were employed. There were no statistically significant differences between the two groups in terms of caregiver gender, age, education level, marital status, relationship to the patient, monthly household income, daily care hours, presence of additional caregivers, or employment status (P > 0.05), indicating comparability (see Table 2 for details). Table 2 Baseline characteristics of caregivers between control group and intervention group Characteristic Number (%) Intervention group(n = 51) Number(%) Control group(n = 51) Number(%) P value Gender 0.830 Male 31(30.4) 15(29.4) 16(31.4) Female 71(69.6) 36(70.6) 35(68.6) Age 51.60 ± 8.49 50.55 ± 8.26 52.65 ± 8.66 0.214 Education level 0.972 Primary school and below 54(52.9) 26(51) 28(54.9) Junior high school 18(17.6) 9(17.6) 9(17.6) Senior high school / Vocational college 21(20.6) 11(21.6) 10(19.6) Undergraduate and above 9(8.9) 5(9.8) 4(7.9) Marriage 0.269 Married 94(92.2) 49(96.1) 45(88.2) Unmarried 8(7.8) 2(3.9) 6(11.8) Relationship with patient 0.833 Spouse 73(71.6) 36(70.6) 37(72.5) Child/daughter-in-law/son-in-law 14(13.7) 8(15.7) 6(11.7) Other 15(14.7) 7(13.7) 8(15.7) Monthly family income 0.874 Less than 1000 yuan 45(44.1) 24(47.0) 21(41.2) 1000–2000 yuan 30(29.4) 14(27.5) 16(31.4) 3000–5000 yuan 14(13.7) 6(11.8) 8(15.7) Over 5000 yuan 13(12.8) 7(13.7) 6(11.7) Daily care time for patient 0.967 Within 4h 33(32.4) 16(31.4) 17(33.3) 4-12h 42(41.2) 21(41.2) 21(41.2) More than 12h 27(26.4) 14(27.4) 13(25.5) Having a co-caregiver 0.565 Yes 14(13.7) 6(11.8) 8(15.7) No 88(86.3) 45(88.2) 43(84.3) Work status 0.909 Employed 60(58.8) 29(56.9) 31(60.8) Retire 11(10.8) 6(11.8) 5(9.8) Unemployed 31(30.4) 16(31.3) 15(29.4) Questionnaire Analysis Using the FCTI scale, caregivers’ caregiving ability was assessed prior to intervention, with a median score of 18 (17–20) in the intervention group and 18 (16–20) in the control group. There were no statistically significant differences between the groups in total FCTI scores or scores across different dimensions (P > 0.05). Similarly, the ZBI was used to assess caregiver burden. The total burden scores were 34.86 ± 8.81 in the intervention group and 34.45 ± 10.00 in the control group, with no significant differences in total, personal, or responsibility burden scores (P > 0.05). Additionally, the SF-36 scale assessed caregivers' quality of life, with pre-intervention total scores of 499.29 ± 25.66 in the intervention group and 506.78 ± 24.65 in the control group. No significant differences were found in total or dimension-specific scores (P > 0.05). Please refer to Table S1 in Supplementary Material 2 for details. Post-Intervention Assessment Post-intervention assessments were conducted at discharge, 3 months, and 6 months after discharge using the FCTI, ZBI, and SF-36 scales. In the FCTI analysis, the intervention group demonstrated significantly lower total scores and scores across all dimensions at discharge, 3 months, and 6 months compared to the control group (P < 0.05). In the ZBI analysis, the intervention group had significantly lower total burden, personal burden, and responsibility burden scores than the control group (P < 0.05). In the SF-36 analysis, the intervention group had significantly higher scores in vitality (VT), social functioning (SF), mental health (MH), and overall quality of life than the control group (P < 0.05). At both 3and 6 months post-discharge, the intervention group consistently showed higher overall quality of life and dimension-specific scores compared to the control group (P < 0.05). Please refer to Tables S2 in Supplementary Material 2 for details. Trajectory Analysis Trajectory fitting was performed on the FCTI, ZBI, and SF-36 scales at discharge, 3 months, and 6 months post-discharge. Based on the Bayesian Information Criterion (BIC), the best-fitting trajectories were selected. In the intervention group’s FCTI trajectory analysis, fitting two trajectory groups yielded the best results: a slow-decline group (class 1) with 9 participants and a rapid-decline-then-plateau group (class 2) with 42 participants. In the control group’s FCTI trajectory analysis, two trajectory groups also provided the best fit: a low-level decline group (class 1) with 22 participants and a high-level decline group (class 2) with 29 participants. Trajectory visualization was conducted for five dimensions of the FCTI in both groups (see Fig. 2 and Figure S1 of Supplementary Material 2). In the SF-36 trajectory analysis for the intervention group, two trajectories were identified: a slow-increase group (class 1) with 21 participants and a rapid-increase-then-plateau group (class 2) with 30 participants. The control group’s SF-36 trajectory analysis also identified two groups: an initial-increase-then-decrease group (class 1) with 12 participants and a continuous-increase group (class 2) with 39 participants. Visualization was performed for the eight SF-36 dimensions in both groups (see Fig. 3 and Figure S2 of Supplementary Material 2). For the ZBI trajectory analysis in the intervention group, three trajectories provided the best fit: a low-level decline group (class 1) with 35 participants, a medium-level decline group (class 2) with 10 participants, and a high-level decline group (class 3) with 6 participants. In the control group, three trajectories were also identified: a medium-level decline group (class 1) with 9 participants, a slow-decline group (class 2) with 32 participants, and a high-level slow-decline group (class 3) with 10 participants. Trajectory visualization was conducted for two dimensions in both groups (see Fig. 4 and Figure S3 of Supplementary Material 2). Trajectory group analysis revealed distribution patterns of patients and caregivers in both the intervention and control groups. In the intervention group’s SF-36 trajectories, there were significant differences in educational levels between groups (P = 0.0032). In the ZBI trajectories, whether there was an additional caregiver also showed significant differences. No other factors showed significant differences. In the control group’s FCTI trajectories, differences were significant in patient insurance status and the relationship between patient and caregiver (P = 0.021 and 0.014, respectively). In the ZBI trajectories, the relationship between patient and caregiver was also significantly different (P = 0.034), with no other significant differences observed. In the FCTI trajectories, the “adapting and assisting” dimension showed the most rapid decline in the intervention group, reaching its lowest point at the third month in the rapid-decline-then-plateau group. In comparison, the slow-decline group showed a trend of recovery. The control group’s low-level decline trajectory paralleled the intervention group’s slow-decline trajectory, suggesting that the TIR model may have limited effectiveness for this subgroup. In the SF-36 trajectories, the intervention group’s rapid-increase-then-plateau group showed a decline at the sixth month, especially in the dimensions of bodily pain (BP), general health (GH), role emotional (RE), and vitality (VT), with BP showing the most pronounced decrease. In the slow-increase group, the RE dimension also showed a downward trend. In the control group, the initial-increase-then-decrease group showed declines mainly in the RE and role physical (RP) dimensions. These comparisons indicated that the TIR model was effective across multiple dimensions, but its impact on the RE dimension was weaker. In the ZBI trajectories, the intervention group showed a slow decline in the high-level group, while the control group showed no significant decline. Dimension analysis indicated that the TIR model effectively reduced the “responsibility burden” but had no significant impact on the “personal burden.” Please refer to Tables S3 and S4 in Supplementary Material 2 for details. Discussion In recent years, the incidence of chronic diseases has been rising steadily[ 31 ]. Hepatic cirrhosis, a prevalent and irreversible chronic disease, poses significant challenges due to its severe and difficult-to-treat nature[ 32 ]. Currently, treatment mainly focuses on symptom management to alleviate the condition[ 33 ]. Hepatic cirrhosis patients often require frequent hospitalizations and long-term care. However, the shortage of medical resources and lagging community health services in China make the role of caregivers crucial in the treatment process. Caregivers not only handle daily care but also manage disease monitoring, symptom control, complication prevention, and emotional support, directly influencing the patient's treatment adherence and quality of life[ 34 ]. Despite this, current healthcare services primarily focus on patients, neglecting the needs of caregivers. Caregivers often lack the knowledge and skills needed to cope with changes in the patient’s condition and bear a significant caregiving burden with insufficient attention to their own physical and mental health[ 35 , 36 ]. Caregivers' needs are dynamic and providing timely support according to different stages is essential. This study, based on TIR, developed nursing intervention measures to enhance the caregiving capabilities of caregivers for patients in the decompensated stage of cirrhosis. This approach reduced caregiver burden and improved their quality of life, providing a theoretical basis for continued care in chronic diseases. Additionally, trajectory analysis was used to assess changes across various dimensions in both the intervention and control groups, offering feedback on the intervention measures and highlighting the importance of intensified intervention. This study analyzed demographic and disease-related data from 102 patients with decompensated cirrhosis and their caregivers. The average age of patients was 54.92 ± 8.78 years, with 73.5% being male, aligning with epidemiological characteristics of cirrhosis[ 5 ]. The majority had low educational levels, with medical costs primarily covered by the New Rural Cooperative Medical Scheme. The majority of patients were classified as Child-Pugh Class C, indicating moderate to severe disease. Caregivers had an average age of 51.60 ± 8.49 years, with 69.6% being female and primarily spouses (71.6%). Most caregivers had low educational levels and low monthly income. Many caregivers managed the caregiving tasks alone, with 58.8% still employed, resulting in a heavy caregiving burden. Pre-intervention, caregivers had low scores on the FCTI, reflecting poor caregiving abilities. This deficiency is primarily due to caregivers being non-professionals with limited nursing knowledge and experience[ 37 ]. Hepatic cirrhosis is complex and rapidly changing, requiring caregivers to quickly adapt to new caregiving roles. However, due to low educational levels, caregivers struggle with acquiring and understanding health education, leaving them unprepared for sudden disease changes. Additionally, many caregivers rely heavily on healthcare professionals for guidance, highlighting their lack of caregiving skills. In terms of caregiving burden, the score was 34.66 ± 9.38, indicating significant strain. This burden is exacerbated by the patient's severe condition, the demanding caregiving tasks, and the caregivers’ lower educational levels. Female caregivers, who often experience higher psychological and physiological stress, are particularly affected[ 38 ]. With 69.6% of caregivers being women and given their older age and declining health, the caregiving burden is further intensified. Many caregivers balance work and caregiving, disrupting their daily routines and leading to role conflict and increased stress. Life quality, as measured by the SF-36 scale, was notably poor, especially in terms of mental health. The significant time and energy investment required for caregiving affects their work, life, and overall well-being. The patient's negative emotions add to the psychological pressure, causing anxiety and depression[ 39 ]. Furthermore, many caregivers, particularly female spouses, manage both caregiving responsibilities and family duties, further impacting their mental health and quality of life. The intervention based on TIR significantly improved caregivers' caregiving abilities. Over time, both the intervention and control groups showed improvement in caregiving capabilities, but the intervention group demonstrated more substantial gains at each time point, indicating the effectiveness of the intervention in promoting proactive learning and adaptation. The intervention group showed faster improvement due to the targeted nature of the measures, which included outpatient visits, phone consultations, and WeChat support, compared to traditional health education. The interactive approach, involving face-to-face guidance, follow-ups, and video education, enhanced caregiving effectiveness. Long-term stress and burden lead to mental health issues such as anxiety and depression, which have become a global public health concern[ 40 , 41 ]. The study found that caregivers of cirrhosis patients generally had poor physical and mental health and experienced high levels of emotional stress[ 11 , 12 ]. Before the intervention, both groups had high caregiving burdens, but post-intervention, the intervention group reported significantly lower scores on burden assessments compared to the control group, with statistically significant differences (P < 0.05). This demonstrates that the TIR-based intervention was more effective than traditional health education. During hospitalization, the TIR group received guidance through manuals and face-to-face explanations, enhancing their knowledge and emotional support[ 42 ], reducing the caregiving burden. Even within three months post-discharge, the intervention group continued to show a downward trend in burden, though at a slower rate, yet still better than the control group. This is attributed to the intervention group’s use of WeChat platforms and support groups for experience sharing and timely guidance, improving confidence and skills. In contrast, the control group struggled with information access and emergency response due to a lack of healthcare provider support. By six months post-discharge, both groups experienced a decline in caregiving burden, but the intervention group’s burden remained significantly lower. The TIR intervention effectively addressed caregivers' needs for information, emotional support, and practical skills at appropriate times, improved caregiving methods, and reduced negative emotions, ultimately lowering the caregiving burden. The control group, due to insufficient caregiving skills and confidence, had a higher burden at various post-discharge points. The TIR-based intervention effectively enhanced the quality of life for caregivers of patients in the decompensated stage of cirrhosis. Quality of life is a comprehensive concept encompassing physical, psychological, and social dimensions, reflecting overall health[ 43 , 44 ]. During caregiving, caregivers face significant stress, impacting their quality of life[ 45 ]. Results showed no significant difference in life quality between the intervention and control groups before the intervention. However, after discharge, the intervention group experienced noticeable improvements in life quality compared to the control group, with statistically significant differences (P < 0.05). This improvement is attributed to the intervention group’s increased knowledge of cirrhosis, enhanced caregiving abilities, and better emotional regulation. Additionally, the caregivers’ accumulated experience in supporting the patient contributed to improved personal health and quality of life. This indicates that the TIR intervention, by addressing caregivers' multifaceted needs, boosted their learning interest, caregiving abilities, and relationship with patients, leading to improved quality of life. Through randomized controlled trials, the TIR-based intervention was shown to improve caregiving abilities and quality of life while reducing caregiving burden. Trajectory analysis was used to evaluate the effectiveness of the intervention and identify which populations benefited most. The FCTI analysis indicated that the primary improvement in caregiving capabilities was through the "adaptation and assistance" dimension. However, trajectory analysis revealed a rebound trend in the intervention group’s rapid decline-slow recovery group after five to six months, suggesting potential caregiver complacency. Therefore, follow-up and reinforcement at this time point are necessary to achieve optimal intervention outcomes. The slow decline group in the intervention and low-level decline group in the control group showed similar trends, indicating that the intervention measures were less effective for this subgroup. Further follow-up is needed to determine if these individuals face additional challenges, such as work and financial pressures, and to adjust intervention measures accordingly for better results. In SF-36 analysis, the intervention significantly improved RE and RP dimensions. The control group showed increased difficulties in these areas, especially in the RE and RP dimensions, indicating the need for targeted interventions around the third to fourth month to stabilize life quality. In ZBI trajectory analysis, the intervention group demonstrated a better declining trend than the control group, though overall effectiveness was limited. High-burden individuals in the control group showed rebound, and despite the intervention’s benefits, the reduction was not significant for this group. Targeted follow-up strategies and additional support are essential for high-burden caregivers to improve outcomes. The analysis of group trajectories provides insight into how intervention measures improve caregivers' capabilities and burden. It also informs the timing and focus of subsequent interventions. Based on trajectory distribution, it is recommended to reinforce and refine interventions after discharge, especially around the sixth month, to address the observed rebound trend. The complexities of cirrhosis, including various complications, impose both physical and psychological challenges on caregivers. Thus, caregivers need extensive medical knowledge and strong psychological resilience. Continuous support and timely assistance from healthcare professionals are crucial[ 46 ]. The study underscores the importance of ongoing and adjusted interventions to effectively support caregivers throughout the caregiving process, reflecting a comprehensive approach to human-centered care. Previous research often centers on patients, focusing primarily on the disease while giving limited attention to the role of caregivers and their evolving needs at different stages[ 47 , 48 ]. This study, guided by Timing Theory and based on the biopsychosocial model, extends the "patient-centered" approach to a "family-centered" model. It provides evidence that targeted, scientifically grounded interventions for caregivers of patients in the decompensated stage of cirrhosis can enhance caregiving capabilities, reduce caregiving burden, and improve caregivers' quality of life. By segmenting the caregiving stages according to the disease's characteristics and developing stage-specific intervention plans, the study offers valuable insights for applying Timing Theory in disease care. Furthermore, trajectory analysis has highlighted areas for improvement and the need for additional time points in intervention planning to achieve sustained and comprehensive support for caregivers. However, this study has limitations. The sample size was constrained by practical factors, with all participants coming from Taizhou Hospital in Zhejiang Province, potentially affecting the representativeness of the sample. Future research should include multi-center, large-scale, randomized trials to validate the findings. Additionally, due to time constraints, the long-term effects of the intervention beyond six months were not assessed. Long-term follow-up of caregivers is necessary to evaluate ongoing changes. Future studies should incorporate more time points to objectively and accurately reflect the medium- and long-term effects of the intervention methods. Conclusion This study, using the Timing Theory framework, designed targeted interventions based on the evolving caregiving needs of caregivers at different stages. The results demonstrate that these interventions effectively enhance caregivers’ caregiving abilities and quality of life while reducing their burden. Feedback from trajectory analysis of dynamic data further supports the importance of regular reinforcement at key time points to strengthen and consolidate the benefits of these interventions. Abbreviations BIC Bayesian Information Criterion BP Bodily pain FCTI Family Caregiver Task Inventory GH General health MH Mental health RE Role emotional RP Role physical SF Social functioning SF-36 36-item Short Form Health Survey TIR Timing It Right VT Vitality ZBI Zarit Caregiver Burden Interview Declarations Ethics approval and consent to participate All methods were carried out in accordance with the Declaration of Helsinki. The study received approval from the Ethics Committee of Taizhou Hospital, Wenzhou Medical University (Ethics Approval No. K20201113). Informed consent was obtained from all study participants. Consent for publication Not applicable. Competing Interests The authors declare no competing interests. Funding This work was supported in part by Medical Science and Technology Project of Zhejiang Province (2021PY083, ¥15000, Shao-wei Li), Program of Taizhou Science and Technology Grant (20ywb29, ¥15000, Shao-wei Li), Major Research Program of Taizhou Enze Medical Center Grant (19EZZDA2, ¥120000, Shao-wei Li), Open Project Program of Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province (21SZDSYS01, ¥100000, Shao-wei Li), Medical Science and Technology Project of Zhejiang Province (2024KY1788, ¥70000, Shao-wei Li), Scientific Research Fundation of Taizhou Enze Medical Center Grant (24EZCG02, ¥20000, Shao-wei Li). Author Contribution XL M, SW L, XY F and WD W participated in the design and implementation of the study. XY F, SY Y, JW L and LY J participated in writing and revising the article. XY F, SY Y, SW L, LY J,YQ S, SP T, SJ X, YJ Zand JW L participated in the collection of data. 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Empowerment, environment and person-centred care: A qualitative study exploring the hospital experience for adults with cognitive impairment. Dement (London). 2019;18(7–8):2710–30. Wallander JL, Schmitt M, Koot HM. Quality of life measurement in children and adolescents: issues, instruments, and applications. J Clin Psychol. 2001;57(4):571–85. Fiume A, Deveber G, Jang SH, Fuller C, Viner S, Friefeld S. Development and validation of the Pediatric Stroke Quality of Life Measure. Dev Med Child Neurol. 2018;60(6):587–95. McCabe M, You E, Tatangelo G. Hearing Their Voice: A Systematic Review of Dementia Family Caregivers' Needs. Gerontologist. 2016;56(5):e70–88. Zhao S, Du R, He Y, He X, Jiang Y, Zhang X. Elements of chronic disease management service system: an empirical study from large hospitals in China. Sci Rep. 2022;12(1):5693. Lee G. The forgotten aspect of chronic disease management: caregivers in atrial fibrillation. Eur J Cardiovasc Nurs 2024. Bodenheimer T, Lorig K, Holman H, Grumbach K. Patient self-management of chronic disease in primary care. JAMA. 2002;288(19):2469–75. Additional Declarations No competing interests reported. Supplementary Files Supplementarymaterial1.docx Supplementarymaterial2.docx SupplementaryMaterial3.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 29 Aug, 2025 Editor assigned by journal 26 Aug, 2025 Editor invited by journal 07 Aug, 2025 Submission checks completed at journal 06 Aug, 2025 First submitted to journal 06 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7223943","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":509743398,"identity":"fe47132c-03be-418f-bf15-de27967aaf20","order_by":0,"name":"Xin-yu Fu","email":"","orcid":"","institution":"Department of Gastroenterology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xin-yu","middleName":"","lastName":"Fu","suffix":""},{"id":509743403,"identity":"edf32d05-68d7-4a71-8741-b9025c8c2dc4","order_by":1,"name":"Si-yan 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2","display":"","copyAsset":false,"role":"figure","size":1509610,"visible":true,"origin":"","legend":"\u003cp\u003eThe trajectory map of FCTI in the intervention group and the distribution of trajectories in each dimension. A. The trajectory distribution of the total score; B. The trajectory distribution of Class 1 in the dimension of \"adaptation to caregiving roles\"; C. The trajectory distribution of Class 2 in the dimension of \"adaptation to caregiving roles\"; D. The trajectory distribution of Class 1 in the dimension of \"strain and assistance provided\"; E. The trajectory distribution of class 2 in the dimension of \"strain and assistance provided\"; F. The trajectory distribution of Class 1 in the dimension of \"handling personal emotions\"; G. The trajectory distribution of Class 2 in the dimension of \"handling personal emotions\"; H. The trajectory distribution of Class 1 in the dimension of \"evaluating family and community resources\"; I. The trajectory distribution of Class 2 in the dimension of \"evaluating family and community resources\"; J. The trajectory distribution of class1 in the dimension of \"adjusting life to meet caregiving needs\"; K. The trajectory distribution of class2 in the dimension of \"adjusting life to meet caregiving needs\".\u003c/p\u003e","description":"","filename":"figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7223943/v1/c5cccdda49b567e906b5d7d9.jpg"},{"id":90880951,"identity":"9969db12-29b1-4da5-bd75-155076602ce3","added_by":"auto","created_at":"2025-09-09 09:39:22","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":2496244,"visible":true,"origin":"","legend":"\u003cp\u003eThe trajectory map of SF-36 in the intervention group and the distribution of trajectories in each dimension. A. The trajectory distribution of the total score;B. The trajectory distribution of Class 1 in the dimension of \"physiological function (PF)\"; C. The trajectory distribution of class 2 in the dimension of \"physiological function (PF)\"; D. The trajectory distribution of Class 1 in the dimension of \"physiological function (RP)\"; E. The trajectory distribution of Class 2 in the dimension of \"physiological function (RP)\"; F. The trajectory distribution of Class 1 in the dimension of \"Physical Pain (BP)\"; G. The trajectory distribution of Class 2 in the dimension of \"Physical Pain (BP)\"; H. The trajectory distribution of Class 1 in the dimension of \"General Health Status (GH)\"; I. The trajectory distribution of Class 2 in the dimension of \"General Health Status (GH)\"; J. The trajectory distribution of class 1 in the dimension of \"energy (VT)\"; K. The trajectory distribution of class 2 in the dimension of \"energy (VT)\"; L. The trajectory distribution of Class 1 in the dimension of \"Social Function (SF)\"; M. The trajectory distribution of Class 2 in the dimension of \"Social Function (SF)\"; N. The trajectory distribution of Class 1 in the dimension of \"Emotional Function (RE)\"; O. The trajectory distribution of Class 2 in the dimension of \"Emotional Function (RE)\"; P. The trajectory distribution of Class 1 in the dimension of \"Mental Health (MH)\"; Q. The trajectory distribution of Class 2 in the dimension of \"Mental Health (MH)\".\u003c/p\u003e","description":"","filename":"figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7223943/v1/f7ecb32ffb92123796a1b1c1.jpg"},{"id":90880955,"identity":"cc71309f-51db-4210-a76b-7465dad2d4f3","added_by":"auto","created_at":"2025-09-09 09:39:23","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":1149276,"visible":true,"origin":"","legend":"\u003cp\u003eThe trajectory map of ZBI in the intervention group and the distribution of trajectories in each dimension. A. The trajectory distribution of the total score; B. The trajectory distribution of Class 1 in the dimension of \"personal burden\"; C. The trajectory distribution of class 1 in the dimension of \"responsibility burden\"; D. The trajectory distribution of class 2 in the dimension of \"personal burden\"; E. The trajectory distribution of class 2 in the dimension of \"responsibility burden\"; F. The trajectory distribution of Class 3 in the dimension of \"personal burden\"; G. The trajectory distribution of class 3 in the dimension of \"responsibility burden\".\u003c/p\u003e","description":"","filename":"figure4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7223943/v1/3d2313f9c3402ab67f9c8e02.jpg"},{"id":90883746,"identity":"37a5ca34-d505-4d7b-a355-0ca6edfbc5a9","added_by":"auto","created_at":"2025-09-09 09:55:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":6611422,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7223943/v1/c1c7cec0-4433-46c5-a753-ed3911dbeb15.pdf"},{"id":90880985,"identity":"2d5c2c11-0984-4bca-ac77-0fe1e4f7591f","added_by":"auto","created_at":"2025-09-09 09:39:27","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":52813,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarymaterial1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7223943/v1/f98d36a054c5dec40c22f236.docx"},{"id":90881644,"identity":"ec742d47-d025-41a4-adf2-57a3dd089a05","added_by":"auto","created_at":"2025-09-09 09:47:20","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":942096,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarymaterial2.docx","url":"https://assets-eu.researchsquare.com/files/rs-7223943/v1/ea350e5167a98ab32d87b49e.docx"},{"id":90880978,"identity":"f715d61d-2686-4c43-98b6-58c6375f68ab","added_by":"auto","created_at":"2025-09-09 09:39:26","extension":"docx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":23764,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterial3.docx","url":"https://assets-eu.researchsquare.com/files/rs-7223943/v1/5bf4e25ee05eb084617b93d3.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Stage-Specific Interventions Based on Timing It Right Theory and Trajectory Analysis Alleviate Burden and Stress of Caregivers for Patients with Decompensated Cirrhosis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eLiver cirrhosis is a chronic, progressive, and diffuse liver injury, representing the end stage of various chronic liver diseases. It poses a growing public health challenge not only in China but also globally[\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The complications associated with cirrhosis are severe and life-threatening, contributing significantly to global mortality rates among adults[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. By 2025, it is projected that 40% of chronic liver disease cases in China will be attributed to cirrhosis, highlighting the urgent need for care and support for both patients and their caregivers. Patients in the decompensated stage of cirrhosis often experience complications such as ascites, hypersplenism, gastrointestinal bleeding, infections, and liver failure[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Managing these conditions requires close cooperation between healthcare professionals and family caregivers.\u003c/p\u003e\u003cp\u003eIn China, family caregivers play a crucial role in providing daily care, financial support, and emotional assistance. However, they also bear significant stress and burden[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Their responsibilities include managing the patient\u0026rsquo;s daily activities, monitoring disease symptoms, ensuring medication adherence, and providing emotional support[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Unfortunately, caregivers often lack the necessary training and support, leading to their own mental and physical strain, which can make them \"hidden patients\" themselves[\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe Timing It Right (TIR) model, developed by Cameron, was originally designed to address the evolving needs of caregivers for stroke patients, emphasizing that caregivers\u0026rsquo; requirements change throughout different stages of the disease[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. This model has been successfully applied to various chronic diseases, showing significant improvements in caregiver well-being and patient outcomes. It has been used internationally for critically ill patients[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], stroke[\u003cspan additionalcitationids=\"CR16 CR17\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], and acute respiratory distress syndrome[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], helping caregivers cope better and facilitating patients' reintegration into family and society. In the context of caring for patients with decompensated liver cirrhosis, the TIR model is equally applicable, as caregivers' experiences and needs vary across different stages and evolve over time. Healthcare professionals should recognize these dynamic changes and provide tailored support and education to help caregivers adapt, enhance their caregiving abilities, reduce their burden, and ultimately promote patient health. The latent class trajectory model takes individual differences into account and groups similar individuals based on dynamic changes in their trajectories[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. This allows healthcare providers to offer more targeted support and education to different populations, optimizing interventions.\u003c/p\u003e\u003cp\u003eThis study, based on the TIR model, aims to explore the specific needs of caregivers of patients with decompensated liver cirrhosis at various stages of care and develop corresponding interventions. Through trajectory-based grouping, the study will further analyze and refine the interventions. The goal is to establish a stage-specific intervention program for caregivers based on the TIR model, validate its effectiveness, and ultimately enhance caregivers\u0026rsquo; skills, reduce their burden, and improve their quality of life. Additionally, by using trajectory feedback, the study will clarify how these interventions achieve their effects. This research aims to provide a theoretical foundation for caregiver interventions in decompensated liver cirrhosis and offer a basis for extending liver cirrhosis care into family and community settings.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003e\u003cstrong\u003ePatients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrom November 2020 to April 2021, patients with decompensated liver cirrhosis and their caregivers were recruited, with caregivers serving as the focus of this study. The inclusion and exclusion criteria for patients and caregivers are as follows:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion criteria for patients:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1. Diagnosed with decompensated liver cirrhosis according to the 2019 \u0026quot;Guidelines for the Diagnosis and Treatment of Liver Cirrhosis.\u0026quot;[22]\u003c/p\u003e\n\u003cp\u003e2. Aged between 18 and 70 years.\u003c/p\u003e\n\u003cp\u003e3. No history of psychiatric disorders or cognitive impairments, with full cognitive and functional abilities to independently complete questionnaires.\u003c/p\u003e\n\u003cp\u003e4. Provided informed consent and voluntarily participated in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion criteria for patients:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1. Severe psychiatric illness or a family history of psychiatric disorders.\u003c/p\u003e\n\u003cp\u003e2. Concurrent hepatic encephalopathy, liver cancer, or severe heart or lung disease, making participation difficult.\u003c/p\u003e\n\u003cp\u003e3. Cognitive impairment or intellectual disability, rendering them unable to understand or complete questionnaires.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion criteria for caregivers:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1. Primary caregivers responsible for patient care during hospitalization and continuing care after discharge (if multiple caregivers are involved, the one with the longest caregiving time or the patient-designated caregiver was chosen).\u003c/p\u003e\n\u003cp\u003e2. Aged between 18 and 70 years.\u003c/p\u003e\n\u003cp\u003e3. No psychiatric disorders, with normal reading and communication abilities.\u003c/p\u003e\n\u003cp\u003e4. Provided informed consent and voluntarily participated in the study.\u003c/p\u003e\n\u003cp\u003e5. Provided at least four hours of care daily.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion criteria for caregivers:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1. Cognitive or communication impairments or emotional instability.\u003c/p\u003e\n\u003cp\u003e2. Unable to complete questionnaires.\u003c/p\u003e\n\u003cp\u003e3. Paid caregivers such as volunteers or hired personnel.\u003c/p\u003e\n\u003cp\u003e4. Serious personal illness.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWithdrawal criteria:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1. Patient\u0026apos;s condition worsens or becomes critical during the study, resulting in discontinuation.\u003c/p\u003e\n\u003cp\u003e2. The patient or caregiver withdraws voluntarily for personal reasons during the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRandomization\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients and caregivers were randomly assigned to either a control group or an intervention group using a computerized randomization method. A non-intervention team member managed group assignment and allocation concealment. During the study, the same physicians and nurses in the two wards were retained, and the wards had identical environments, with comparable staff numbers, educational backgrounds, and professional titles. The control group received standard health education and follow-up care, while the intervention group received additional interventions based on the TIR model.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGeneral Data:\u003c/p\u003e\n\u003cp\u003e1. Patient information: gender, age, education level, employment status, marital status, time since cirrhosis diagnosis, knowledge of liver cirrhosis, type of medical insurance, and Child-Pugh classification of liver function.\u003c/p\u003e\n\u003cp\u003e2. Caregiver information: gender, age, education level, marital status, relationship to the patient, household monthly income, daily caregiving hours, presence of additional caregivers, and employment status.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuestionnaire Data:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWithin 48 hours of patient admission, the study team explained the research purpose, significance, and questionnaire instructions to eligible patients and caregivers, obtaining informed consent. Questionnaires were used to assess caregiving ability, burden, and quality of life. These were administered at admission, discharge, and three and six months after discharge. For participants with reading or vision impairments, the researcher assisted in completing the questionnaires. Data were collected through hospital visits, telephone follow-ups, or home visits, ensuring the accuracy and completeness of responses. The three questionnaires used were the Family Caregiver Task Inventory (FCTI)[23, 24], the Zarit Caregiver Burden Interview (ZBI)[25, 26], and the 36-item Short Form Health Survey (SF-36)[27-29]. FCTI scores indicate caregiving difficulty and lower caregiving ability with higher scores. Higher ZBI scores reflect a greater caregiver burden, while higher SF-36 scores indicate a better quality of life[30]. Detailed information on the questionnaires can be found in the supplementary materials.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInterventions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe control group received standard digestive department health education, including admission education, health guidance, discharge planning, and post-discharge follow-up. The intervention group received additional stage-based interventions guided by the TIR model. The design process for the TIR-based intervention plan is detailed in the supplementary materials 1. Figure 1 shows the entire experimental process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter double-checking the data, R language and the \u0026quot;lcmm\u0026quot; package were used for data processing and analysis to determine the best trajectory grouping. SPSS 26.0 software was used for descriptive statistical analysis of demographic data, with age, gender, and education level presented as means and standard deviations or percentages. Normally distributed data were described with means and standard deviations, while non-normally distributed data were analyzed using the Mann-Whitney U test and described with medians and interquartile ranges. Two-sample t-tests and repeated measures analysis of variance were employed to compare differences between the two groups at various time points, assessing the intervention\u0026apos;s effectiveness. A significance level of \u0026alpha; = 0.05 was applied, with P-values less than 0.05 considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eBased on the formula for comparing two sample means, the required sample size for each group was calculated to be 44. To account for a potential 20% dropout rate, the final sample size was determined to be 55 participants per group, totaling 110 participants. These participants were then divided into the intervention and control groups, with 55 participants in each. By the end of the study, 51 valid samples were collected from each group. In the control group, four participants were lost to follow-up: two patients died due to worsening conditions, one caregiver was unreachable due to a change in phone number, and one caregiver was replaced. In the intervention group, four participants were also lost: one patient was cared for by a hired caregiver after discharge, one patient died, and two caregivers withdrew due to personal health issues. The overall dropout rate was 7.27%.\u003c/p\u003e\n\u003ch3\u003eBaseline Characteristics\u003c/h3\u003e\n\u003cp\u003eThe majority of the patients were male (73.5%) with a mean age of 54.92\u0026thinsp;\u0026plusmn;\u0026thinsp;8.78 years. Most had a low level of education, with 34.3% having a middle school education and 30.4% having only primary education or less. Many were farmers (56.9%), and 91.2% were married. There were no statistically significant differences between the two groups in terms of gender, age, education level, occupation, marital status, time since liver cirrhosis diagnosis, knowledge of liver cirrhosis, type of medical insurance, or Child-Pugh classification (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05), making the groups comparable (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e for details).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline characteristics of patients between control group and intervention group\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIntervention group(n\u0026thinsp;=\u0026thinsp;51)\u003c/p\u003e\u003cp\u003eNumber(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eControl group(n\u0026thinsp;=\u0026thinsp;51)Number༈%༉\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e0.501\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e75(73.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39(76.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e36(70.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e27(26.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12(23.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e15(29.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e54.92\u0026thinsp;\u0026plusmn;\u0026thinsp;8.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e54.39\u0026thinsp;\u0026plusmn;\u0026thinsp;8.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e55.45\u0026thinsp;\u0026plusmn;\u0026thinsp;8.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.545\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducation level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e0.756\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary school and below\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e31(30.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17(33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e14(27.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJunior high school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e35(34.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15(29.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e20(39.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSenior high school / Vocational college\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14(13.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7(13.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7(13.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUndergraduate and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e22(21.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12(23.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10(19.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWork status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e0.930\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFarmer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e58(56.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28(54.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e30(58.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnemployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18(17.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10(19.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8(15.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRetire\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15(14.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8(15.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7(13.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e11(10.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5(9.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6(11.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarriage\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e0.485\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e93(91.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45(88.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e48(94.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnmarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9(8.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6(11.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3(5.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTime of detecting liver cirrhosis\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;1 year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e54(52.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26(51)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e28(54.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.780\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u0026ndash;5 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e22(21.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13(25.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9(17.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u0026ndash;10 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12(11.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6(11.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6(11.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;10 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14(13.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6(11.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8(15.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eUnderstanding of liver cirrhosis\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.993\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVery familiar\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12(11.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6(11.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6(11.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFairly familiar\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17(16.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8(15.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9(17.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerately familiar\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e36(35.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18(35.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e18(35.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot familiar\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e37(36.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19(37.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e18(35.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTypes of medical expenses\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e0.848\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGovernment-funded healthcare\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16(15.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9(17.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7(13.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNew rural cooperative medical scheme\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e71(69.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35(68.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e36(70.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedical insurance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15(14.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7(13.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8(15.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eChild-Pugh grade\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e0.426\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClass B\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e46(45.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25(49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e21(41.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClass C\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e56(54.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26(51)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e30(58.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAmong caregivers, the majority were female (69.6%) with a mean age of 51.60\u0026thinsp;\u0026plusmn;\u0026thinsp;8.49 years. Most caregivers had low educational levels, with 52.9% having primary education or less, and 92.2% were married. The majority of caregivers were the patients\u0026rsquo; spouses (71.6%). Approximately 44.1% of caregivers reported a household monthly income below 1000 RMB, and 41.2% provided 4\u0026ndash;12 hours of care per day. Most caregivers (86.3%) were the sole providers of care, with only 13.7% having additional caregivers. Additionally, 58.8% of caregivers were employed. There were no statistically significant differences between the two groups in terms of caregiver gender, age, education level, marital status, relationship to the patient, monthly household income, daily care hours, presence of additional caregivers, or employment status (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05), indicating comparability (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e for details).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline characteristics of caregivers between control group and intervention group\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIntervention group(n\u0026thinsp;=\u0026thinsp;51)\u003c/p\u003e\u003cp\u003eNumber(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eControl group(n\u0026thinsp;=\u0026thinsp;51)\u003c/p\u003e\u003cp\u003eNumber(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.830\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e31(30.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15(29.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e16(31.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e71(69.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36(70.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e35(68.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e51.60\u0026thinsp;\u0026plusmn;\u0026thinsp;8.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50.55\u0026thinsp;\u0026plusmn;\u0026thinsp;8.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e52.65\u0026thinsp;\u0026plusmn;\u0026thinsp;8.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.214\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducation level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.972\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary school and below\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e54(52.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26(51)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e28(54.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJunior high school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18(17.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9(17.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9(17.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSenior high school / Vocational college\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e21(20.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11(21.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10(19.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUndergraduate and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9(8.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5(9.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4(7.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarriage\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.269\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e94(92.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e49(96.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e45(88.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnmarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8(7.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2(3.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6(11.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRelationship with patient\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.833\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpouse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e73(71.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36(70.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e37(72.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChild/daughter-in-law/son-in-law\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14(13.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8(15.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6(11.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15(14.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7(13.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8(15.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMonthly family income\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.874\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLess than 1000 yuan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e45(44.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24(47.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e21(41.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1000\u0026ndash;2000 yuan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e30(29.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14(27.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e16(31.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3000\u0026ndash;5000 yuan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14(13.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6(11.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8(15.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOver 5000 yuan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e13(12.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7(13.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6(11.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDaily care time for patient\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.967\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 4h\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e33(32.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16(31.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e17(33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4-12h\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e42(41.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21(41.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e21(41.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMore than 12h\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e27(26.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14(27.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e13(25.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHaving a\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eco-caregiver\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.565\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14(13.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6(11.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8(15.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e88(86.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45(88.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e43(84.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWork status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.909\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e60(58.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29(56.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e31(60.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRetire\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e11(10.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6(11.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5(9.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnemployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e31(30.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16(31.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e15(29.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eQuestionnaire Analysis\u003c/h2\u003e\u003cp\u003eUsing the FCTI scale, caregivers\u0026rsquo; caregiving ability was assessed prior to intervention, with a median score of 18 (17\u0026ndash;20) in the intervention group and 18 (16\u0026ndash;20) in the control group. There were no statistically significant differences between the groups in total FCTI scores or scores across different dimensions (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Similarly, the ZBI was used to assess caregiver burden. The total burden scores were 34.86\u0026thinsp;\u0026plusmn;\u0026thinsp;8.81 in the intervention group and 34.45\u0026thinsp;\u0026plusmn;\u0026thinsp;10.00 in the control group, with no significant differences in total, personal, or responsibility burden scores (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Additionally, the SF-36 scale assessed caregivers' quality of life, with pre-intervention total scores of 499.29\u0026thinsp;\u0026plusmn;\u0026thinsp;25.66 in the intervention group and 506.78\u0026thinsp;\u0026plusmn;\u0026thinsp;24.65 in the control group. No significant differences were found in total or dimension-specific scores (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Please refer to Table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e in Supplementary Material 2 for details.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003ePost-Intervention Assessment\u003c/h2\u003e\u003cp\u003ePost-intervention assessments were conducted at discharge, 3 months, and 6 months after discharge using the FCTI, ZBI, and SF-36 scales. In the FCTI analysis, the intervention group demonstrated significantly lower total scores and scores across all dimensions at discharge, 3 months, and 6 months compared to the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). In the ZBI analysis, the intervention group had significantly lower total burden, personal burden, and responsibility burden scores than the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). In the SF-36 analysis, the intervention group had significantly higher scores in vitality (VT), social functioning (SF), mental health (MH), and overall quality of life than the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). At both 3and 6 months post-discharge, the intervention group consistently showed higher overall quality of life and dimension-specific scores compared to the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Please refer to Tables S2 in Supplementary Material 2 for details.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eTrajectory Analysis\u003c/h2\u003e\u003cp\u003eTrajectory fitting was performed on the FCTI, ZBI, and SF-36 scales at discharge, 3 months, and 6 months post-discharge. Based on the Bayesian Information Criterion (BIC), the best-fitting trajectories were selected. In the intervention group\u0026rsquo;s FCTI trajectory analysis, fitting two trajectory groups yielded the best results: a slow-decline group (class 1) with 9 participants and a rapid-decline-then-plateau group (class 2) with 42 participants. In the control group\u0026rsquo;s FCTI trajectory analysis, two trajectory groups also provided the best fit: a low-level decline group (class 1) with 22 participants and a high-level decline group (class 2) with 29 participants. Trajectory visualization was conducted for five dimensions of the FCTI in both groups (see Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Figure \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e of Supplementary Material 2).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eIn the SF-36 trajectory analysis for the intervention group, two trajectories were identified: a slow-increase group (class 1) with 21 participants and a rapid-increase-then-plateau group (class 2) with 30 participants. The control group\u0026rsquo;s SF-36 trajectory analysis also identified two groups: an initial-increase-then-decrease group (class 1) with 12 participants and a continuous-increase group (class 2) with 39 participants. Visualization was performed for the eight SF-36 dimensions in both groups (see Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and Figure \u003cspan refid=\"MOESM2\" class=\"InternalRef\"\u003eS2\u003c/span\u003e of Supplementary Material 2).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eFor the ZBI trajectory analysis in the intervention group, three trajectories provided the best fit: a low-level decline group (class 1) with 35 participants, a medium-level decline group (class 2) with 10 participants, and a high-level decline group (class 3) with 6 participants. In the control group, three trajectories were also identified: a medium-level decline group (class 1) with 9 participants, a slow-decline group (class 2) with 32 participants, and a high-level slow-decline group (class 3) with 10 participants. Trajectory visualization was conducted for two dimensions in both groups (see Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e and Figure \u003cspan refid=\"MOESM3\" class=\"InternalRef\"\u003eS3\u003c/span\u003e of Supplementary Material 2).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e Trajectory group analysis revealed distribution patterns of patients and caregivers in both the intervention and control groups. In the intervention group\u0026rsquo;s SF-36 trajectories, there were significant differences in educational levels between groups (P\u0026thinsp;=\u0026thinsp;0.0032). In the ZBI trajectories, whether there was an additional caregiver also showed significant differences. No other factors showed significant differences. In the control group\u0026rsquo;s FCTI trajectories, differences were significant in patient insurance status and the relationship between patient and caregiver (P\u0026thinsp;=\u0026thinsp;0.021 and 0.014, respectively). In the ZBI trajectories, the relationship between patient and caregiver was also significantly different (P\u0026thinsp;=\u0026thinsp;0.034), with no other significant differences observed.\u003c/p\u003e\u003cp\u003eIn the FCTI trajectories, the \u0026ldquo;adapting and assisting\u0026rdquo; dimension showed the most rapid decline in the intervention group, reaching its lowest point at the third month in the rapid-decline-then-plateau group. In comparison, the slow-decline group showed a trend of recovery. The control group\u0026rsquo;s low-level decline trajectory paralleled the intervention group\u0026rsquo;s slow-decline trajectory, suggesting that the TIR model may have limited effectiveness for this subgroup. In the SF-36 trajectories, the intervention group\u0026rsquo;s rapid-increase-then-plateau group showed a decline at the sixth month, especially in the dimensions of bodily pain (BP), general health (GH), role emotional (RE), and vitality (VT), with BP showing the most pronounced decrease. In the slow-increase group, the RE dimension also showed a downward trend. In the control group, the initial-increase-then-decrease group showed declines mainly in the RE and role physical (RP) dimensions. These comparisons indicated that the TIR model was effective across multiple dimensions, but its impact on the RE dimension was weaker. In the ZBI trajectories, the intervention group showed a slow decline in the high-level group, while the control group showed no significant decline. Dimension analysis indicated that the TIR model effectively reduced the \u0026ldquo;responsibility burden\u0026rdquo; but had no significant impact on the \u0026ldquo;personal burden.\u0026rdquo; Please refer to Tables S3 and S4 in Supplementary Material 2 for details.\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn recent years, the incidence of chronic diseases has been rising steadily[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Hepatic cirrhosis, a prevalent and irreversible chronic disease, poses significant challenges due to its severe and difficult-to-treat nature[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Currently, treatment mainly focuses on symptom management to alleviate the condition[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Hepatic cirrhosis patients often require frequent hospitalizations and long-term care. However, the shortage of medical resources and lagging community health services in China make the role of caregivers crucial in the treatment process. Caregivers not only handle daily care but also manage disease monitoring, symptom control, complication prevention, and emotional support, directly influencing the patient's treatment adherence and quality of life[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Despite this, current healthcare services primarily focus on patients, neglecting the needs of caregivers. Caregivers often lack the knowledge and skills needed to cope with changes in the patient\u0026rsquo;s condition and bear a significant caregiving burden with insufficient attention to their own physical and mental health[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Caregivers' needs are dynamic and providing timely support according to different stages is essential. This study, based on TIR, developed nursing intervention measures to enhance the caregiving capabilities of caregivers for patients in the decompensated stage of cirrhosis. This approach reduced caregiver burden and improved their quality of life, providing a theoretical basis for continued care in chronic diseases. Additionally, trajectory analysis was used to assess changes across various dimensions in both the intervention and control groups, offering feedback on the intervention measures and highlighting the importance of intensified intervention.\u003c/p\u003e\u003cp\u003eThis study analyzed demographic and disease-related data from 102 patients with decompensated cirrhosis and their caregivers. The average age of patients was 54.92\u0026thinsp;\u0026plusmn;\u0026thinsp;8.78 years, with 73.5% being male, aligning with epidemiological characteristics of cirrhosis[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The majority had low educational levels, with medical costs primarily covered by the New Rural Cooperative Medical Scheme. The majority of patients were classified as Child-Pugh Class C, indicating moderate to severe disease. Caregivers had an average age of 51.60\u0026thinsp;\u0026plusmn;\u0026thinsp;8.49 years, with 69.6% being female and primarily spouses (71.6%). Most caregivers had low educational levels and low monthly income. Many caregivers managed the caregiving tasks alone, with 58.8% still employed, resulting in a heavy caregiving burden. Pre-intervention, caregivers had low scores on the FCTI, reflecting poor caregiving abilities. This deficiency is primarily due to caregivers being non-professionals with limited nursing knowledge and experience[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Hepatic cirrhosis is complex and rapidly changing, requiring caregivers to quickly adapt to new caregiving roles. However, due to low educational levels, caregivers struggle with acquiring and understanding health education, leaving them unprepared for sudden disease changes. Additionally, many caregivers rely heavily on healthcare professionals for guidance, highlighting their lack of caregiving skills. In terms of caregiving burden, the score was 34.66\u0026thinsp;\u0026plusmn;\u0026thinsp;9.38, indicating significant strain. This burden is exacerbated by the patient's severe condition, the demanding caregiving tasks, and the caregivers\u0026rsquo; lower educational levels. Female caregivers, who often experience higher psychological and physiological stress, are particularly affected[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. With 69.6% of caregivers being women and given their older age and declining health, the caregiving burden is further intensified. Many caregivers balance work and caregiving, disrupting their daily routines and leading to role conflict and increased stress. Life quality, as measured by the SF-36 scale, was notably poor, especially in terms of mental health. The significant time and energy investment required for caregiving affects their work, life, and overall well-being. The patient's negative emotions add to the psychological pressure, causing anxiety and depression[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Furthermore, many caregivers, particularly female spouses, manage both caregiving responsibilities and family duties, further impacting their mental health and quality of life.\u003c/p\u003e\u003cp\u003eThe intervention based on TIR significantly improved caregivers' caregiving abilities. Over time, both the intervention and control groups showed improvement in caregiving capabilities, but the intervention group demonstrated more substantial gains at each time point, indicating the effectiveness of the intervention in promoting proactive learning and adaptation. The intervention group showed faster improvement due to the targeted nature of the measures, which included outpatient visits, phone consultations, and WeChat support, compared to traditional health education. The interactive approach, involving face-to-face guidance, follow-ups, and video education, enhanced caregiving effectiveness.\u003c/p\u003e\u003cp\u003eLong-term stress and burden lead to mental health issues such as anxiety and depression, which have become a global public health concern[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. The study found that caregivers of cirrhosis patients generally had poor physical and mental health and experienced high levels of emotional stress[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Before the intervention, both groups had high caregiving burdens, but post-intervention, the intervention group reported significantly lower scores on burden assessments compared to the control group, with statistically significant differences (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). This demonstrates that the TIR-based intervention was more effective than traditional health education. During hospitalization, the TIR group received guidance through manuals and face-to-face explanations, enhancing their knowledge and emotional support[\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e], reducing the caregiving burden. Even within three months post-discharge, the intervention group continued to show a downward trend in burden, though at a slower rate, yet still better than the control group. This is attributed to the intervention group\u0026rsquo;s use of WeChat platforms and support groups for experience sharing and timely guidance, improving confidence and skills. In contrast, the control group struggled with information access and emergency response due to a lack of healthcare provider support. By six months post-discharge, both groups experienced a decline in caregiving burden, but the intervention group\u0026rsquo;s burden remained significantly lower. The TIR intervention effectively addressed caregivers' needs for information, emotional support, and practical skills at appropriate times, improved caregiving methods, and reduced negative emotions, ultimately lowering the caregiving burden. The control group, due to insufficient caregiving skills and confidence, had a higher burden at various post-discharge points.\u003c/p\u003e\u003cp\u003eThe TIR-based intervention effectively enhanced the quality of life for caregivers of patients in the decompensated stage of cirrhosis. Quality of life is a comprehensive concept encompassing physical, psychological, and social dimensions, reflecting overall health[\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. During caregiving, caregivers face significant stress, impacting their quality of life[\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Results showed no significant difference in life quality between the intervention and control groups before the intervention. However, after discharge, the intervention group experienced noticeable improvements in life quality compared to the control group, with statistically significant differences (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). This improvement is attributed to the intervention group\u0026rsquo;s increased knowledge of cirrhosis, enhanced caregiving abilities, and better emotional regulation. Additionally, the caregivers\u0026rsquo; accumulated experience in supporting the patient contributed to improved personal health and quality of life. This indicates that the TIR intervention, by addressing caregivers' multifaceted needs, boosted their learning interest, caregiving abilities, and relationship with patients, leading to improved quality of life.\u003c/p\u003e\u003cp\u003eThrough randomized controlled trials, the TIR-based intervention was shown to improve caregiving abilities and quality of life while reducing caregiving burden. Trajectory analysis was used to evaluate the effectiveness of the intervention and identify which populations benefited most. The FCTI analysis indicated that the primary improvement in caregiving capabilities was through the \"adaptation and assistance\" dimension. However, trajectory analysis revealed a rebound trend in the intervention group\u0026rsquo;s rapid decline-slow recovery group after five to six months, suggesting potential caregiver complacency. Therefore, follow-up and reinforcement at this time point are necessary to achieve optimal intervention outcomes. The slow decline group in the intervention and low-level decline group in the control group showed similar trends, indicating that the intervention measures were less effective for this subgroup. Further follow-up is needed to determine if these individuals face additional challenges, such as work and financial pressures, and to adjust intervention measures accordingly for better results. In SF-36 analysis, the intervention significantly improved RE and RP dimensions. The control group showed increased difficulties in these areas, especially in the RE and RP dimensions, indicating the need for targeted interventions around the third to fourth month to stabilize life quality. In ZBI trajectory analysis, the intervention group demonstrated a better declining trend than the control group, though overall effectiveness was limited. High-burden individuals in the control group showed rebound, and despite the intervention\u0026rsquo;s benefits, the reduction was not significant for this group. Targeted follow-up strategies and additional support are essential for high-burden caregivers to improve outcomes.\u003c/p\u003e\u003cp\u003eThe analysis of group trajectories provides insight into how intervention measures improve caregivers' capabilities and burden. It also informs the timing and focus of subsequent interventions. Based on trajectory distribution, it is recommended to reinforce and refine interventions after discharge, especially around the sixth month, to address the observed rebound trend. The complexities of cirrhosis, including various complications, impose both physical and psychological challenges on caregivers. Thus, caregivers need extensive medical knowledge and strong psychological resilience. Continuous support and timely assistance from healthcare professionals are crucial[\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. The study underscores the importance of ongoing and adjusted interventions to effectively support caregivers throughout the caregiving process, reflecting a comprehensive approach to human-centered care.\u003c/p\u003e\u003cp\u003ePrevious research often centers on patients, focusing primarily on the disease while giving limited attention to the role of caregivers and their evolving needs at different stages[\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. This study, guided by Timing Theory and based on the biopsychosocial model, extends the \"patient-centered\" approach to a \"family-centered\" model. It provides evidence that targeted, scientifically grounded interventions for caregivers of patients in the decompensated stage of cirrhosis can enhance caregiving capabilities, reduce caregiving burden, and improve caregivers' quality of life. By segmenting the caregiving stages according to the disease's characteristics and developing stage-specific intervention plans, the study offers valuable insights for applying Timing Theory in disease care. Furthermore, trajectory analysis has highlighted areas for improvement and the need for additional time points in intervention planning to achieve sustained and comprehensive support for caregivers.\u003c/p\u003e\u003cp\u003eHowever, this study has limitations. The sample size was constrained by practical factors, with all participants coming from Taizhou Hospital in Zhejiang Province, potentially affecting the representativeness of the sample. Future research should include multi-center, large-scale, randomized trials to validate the findings. Additionally, due to time constraints, the long-term effects of the intervention beyond six months were not assessed. Long-term follow-up of caregivers is necessary to evaluate ongoing changes. Future studies should incorporate more time points to objectively and accurately reflect the medium- and long-term effects of the intervention methods.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003e This study, using the Timing Theory framework, designed targeted interventions based on the evolving caregiving needs of caregivers at different stages. The results demonstrate that these interventions effectively enhance caregivers\u0026rsquo; caregiving abilities and quality of life while reducing their burden. Feedback from trajectory analysis of dynamic data further supports the importance of regular reinforcement at key time points to strengthen and consolidate the benefits of these interventions.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eBIC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eBayesian Information Criterion\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eBP\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eBodily pain\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eFCTI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eFamily Caregiver Task Inventory\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eGH\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eGeneral health\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMH\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMental health\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eRE\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eRole emotional\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eRP\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eRole physical\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSF\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eSocial functioning\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSF-36\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003e36-item Short Form Health Survey\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eTIR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eTiming It Right\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eVT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eVitality\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eZBI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eZarit Caregiver Burden Interview\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eAll methods were carried out in accordance with the Declaration of Helsinki. The study received approval from the Ethics Committee of Taizhou Hospital, Wenzhou Medical University (Ethics Approval No. K20201113). Informed consent was obtained from all study participants.\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eCompeting Interests\u003c/h2\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThis work was supported in part by Medical Science and Technology Project of Zhejiang Province (2021PY083, \u0026yen;15000, Shao-wei Li), Program of Taizhou Science and Technology Grant (20ywb29, \u0026yen;15000, Shao-wei Li), Major Research Program of Taizhou Enze Medical Center Grant (19EZZDA2, \u0026yen;120000, Shao-wei Li), Open Project Program of Key Laboratory of Minimally Invasive Techniques \u0026amp; Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province (21SZDSYS01, \u0026yen;100000, Shao-wei Li), Medical Science and Technology Project of Zhejiang Province (2024KY1788, \u0026yen;70000, Shao-wei Li), Scientific Research Fundation of Taizhou Enze Medical Center Grant (24EZCG02, \u0026yen;20000, Shao-wei Li).\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eXL M, SW L, XY F and WD W participated in the design and implementation of the study. XY F, SY Y, JW L and LY J participated in writing and revising the article. XY F, SY Y, SW L, LY J,YQ S, SP T, SJ X, YJ Zand JW L participated in the collection of data. All authors contributed to the article and approved the submitted version.\u003c/p\u003e\n\u003ch2\u003eAcknowledgements\u003c/h2\u003e\n\u003cp\u003eNo acknowledgments for this study.\u003c/p\u003e\n\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\n\u003cp\u003eThe datasets generated during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMerriman RB, Tran TT. AASLD practice guidelines: The past, the present, and the future. Hepatology. 2016;63(1):31\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eScaglione S, Kliethermes S, Cao G, Shoham D, Durazo R, Luke A, Volk ML. The Epidemiology of Cirrhosis in the United States: A Population-based Study. 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Education and support needs during recovery in acute respiratory distress syndrome survivors. Crit Care. 2009;13(5):R153.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVistisen D, Witte DR, Tab\u0026aacute;k AG, Herder C, Brunner EJ, Kivim\u0026auml;ki M, F\u0026aelig;rch K. Patterns of obesity development before the diagnosis of type 2 diabetes: the Whitehall II cohort study. PLoS Med. 2014;11(2):e1001602.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGeifman N, Kennedy RE, Schneider LS, Buchan I, Brinton RD. Data-driven identification of endophenotypes of Alzheimer's disease progression: implications for clinical trials and therapeutic interventions. Alzheimers Res Ther. 2018;10(1):4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e[Chinese guidelines on the management of liver cirrhosis]. Zhonghua Gan Zang Bing Za Zhi. 2019;27(11):846\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eClark NM, Rakowski W. Family caregivers of older adults: improving helping skills. Gerontologist. 1983;23(6):637\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLee RL, Mok ES. Evaluation of the psychometric properties of a modified Chinese version of the Caregiver Task Inventory\u0026ndash;refinement and psychometric testing of the Chinese Caregiver Task Inventory: a confirmatory factor analysis. J Clin Nurs. 2011;20(23\u0026ndash;24):3452\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZarit SH, Todd PA, Zarit JM. Subjective burden of husbands and wives as caregivers: a longitudinal study. Gerontologist. 1986;26(3):260\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang L, Yang X, Hou Z. Application and evaluation of chinese version of zarit caregiver burden interview. Chin J Public Health. 2006;22(8):970\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePourmomeny AA, Zargham M, Fani M. 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J Neurol Sci. 2019;399:151\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGlobal incidence. prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990\u0026ndash;2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2024;403(10440):2133\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStarr SP, Raines D. Cirrhosis: diagnosis, management, and prevention. Am Fam Physician. 2011;84(12):1353\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRogal SS, Hansen L, Patel A, Ufere NN, Verma M, Woodrell CD, Kanwal F. AASLD Practice Guidance: Palliative care and symptom-based management in decompensated cirrhosis. Hepatology. 2022;76(3):819\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSchulman-Green D, Feder SL, Dionne-Odom JN, Batten J, En Long VJ, Harris Y, Wilpers A, Wong T, Whittemore R. Family Caregiver Support of Patient Self-Management During Chronic, Life-Limiting Illness: A Qualitative Metasynthesis. J Fam Nurs. 2021;27(1):55\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eUllrich A, Ascherfeld L, Marx G, Bokemeyer C, Bergelt C, Oechsle K. Quality of life, psychological burden, needs, and satisfaction during specialized inpatient palliative care in family caregivers of advanced cancer patients. BMC Palliat Care. 2017;16(1):31.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBorges EL, Franceschini J, Costa LH, Fernandes AL, Jamnik S, Santoro IL. Family caregiver burden: the burden of caring for lung cancer patients according to the cancer stage and patient quality of life. J Bras Pneumol. 2017;43(1):18\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChiao CY, Wu HS, Hsiao CY. Caregiver burden for informal caregivers of patients with dementia: A systematic review. Int Nurs Rev. 2015;62(3):340\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLindt N, van Berkel J, Mulder BC. Determinants of overburdening among informal carers: a systematic review. BMC Geriatr. 2020;20(1):304.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHickman RL Jr., Douglas SL. Impact of chronic critical illness on the psychological outcomes of family members. AACN Adv Crit Care. 2010;21(1):80\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang M, He B, Wang Y, Wu F, Chen X, Wang W, Yang X. Depression among Low-Income Female Muslim Uyghur and Kazakh Informal Caregivers of Disabled Elders in Far Western China: Influence on the Caregivers' Burden and the Disabled Elders' Quality of Life. PLoS ONE. 2016;11(5):e0156382.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLv R, Yang L, Li J, Kuang J, Zhou K, Xu M. Depression Mediates the Association Between Burden and Quality of Life in Informal Caregivers of Stroke Survivors: Meta-analytic Structural Equation Modeling. Arch Phys Med Rehabil 2024.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePrato L, Lindley L, Boyles M, Robinson L, Abley C. Empowerment, environment and person-centred care: A qualitative study exploring the hospital experience for adults with cognitive impairment. Dement (London). 2019;18(7\u0026ndash;8):2710\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWallander JL, Schmitt M, Koot HM. Quality of life measurement in children and adolescents: issues, instruments, and applications. J Clin Psychol. 2001;57(4):571\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFiume A, Deveber G, Jang SH, Fuller C, Viner S, Friefeld S. Development and validation of the Pediatric Stroke Quality of Life Measure. Dev Med Child Neurol. 2018;60(6):587\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMcCabe M, You E, Tatangelo G. Hearing Their Voice: A Systematic Review of Dementia Family Caregivers' Needs. Gerontologist. 2016;56(5):e70\u0026ndash;88.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhao S, Du R, He Y, He X, Jiang Y, Zhang X. Elements of chronic disease management service system: an empirical study from large hospitals in China. Sci Rep. 2022;12(1):5693.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLee G. The forgotten aspect of chronic disease management: caregivers in atrial fibrillation. Eur J Cardiovasc Nurs 2024.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBodenheimer T, Lorig K, Holman H, Grumbach K. Patient self-management of chronic disease in primary care. JAMA. 2002;288(19):2469\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Timing It Right model, Caregiver, Intervene, Trajectory analysis","lastPublishedDoi":"10.21203/rs.3.rs-7223943/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7223943/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e\u003cp\u003eThis study aimed to develop targeted interventions for caregivers of patients with decompensated cirrhosis, guided by the Timing It Right (TIR) model, to assess the impact on caregiving ability, burden, and quality of life across care stages.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e\u003cp\u003eA total of 110 caregivers were recruited and randomly assigned to either a control group receiving routine health education or an intervention group receiving TIR-based interventions. Caregiving ability, burden, and quality of life were assessed at baseline, discharge, and at 3 and 6 months post-discharge. Trajectory analysis was applied to visualize intervention effects.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eOf 102 participants completing the study, caregivers in the intervention group demonstrated significantly lower caregiving burden and higher quality of life at both 3 and 6 months post-discharge compared to controls (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Trajectory analysis suggested the interventions effectively reduced psychological burden, although some caregivers showed rebound effects, indicating a need for sustained support.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eTIR-based interventions tailored to caregiving stages enhance caregiver ability, reduce burden, and improve quality of life. These findings suggest that integrating stage-specific support for caregivers in clinical settings can better address their evolving needs, positively impacting patient outcomes. Regular reinforcement of interventions is recommended to maintain these benefits over time.\u003c/p\u003e\u003ch2\u003eImplications for Clinical Practice:\u003c/h2\u003e\u003cp\u003eImplementing stage-specific interventions for caregivers can provide crucial support and relief, enabling better patient care and caregiver resilience. Tailoring interventions based on trajectory feedback further optimizes the timing and long-term effectiveness of caregiver support strategies.\u003c/p\u003e","manuscriptTitle":"Stage-Specific Interventions Based on Timing It Right Theory and Trajectory Analysis Alleviate Burden and Stress of Caregivers for Patients with Decompensated Cirrhosis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-09 09:39:04","doi":"10.21203/rs.3.rs-7223943/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2025-08-29T14:07:30+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-26T15:57:28+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-07T06:26:45+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-06T13:49:20+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-08-06T13:46:07+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6b3245ab-0699-45c4-9cb9-901c8082b672","owner":[],"postedDate":"September 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-09-09T09:39:04+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-09 09:39:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7223943","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7223943","identity":"rs-7223943","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}