Nurse-led virtual clinic for liver cirrhosis: impact on quality of life and health outcomes – a mixed methods research proposal

Liver cirrhosis causes high mortality and morbidity, affecting patients' quality of life (QoL) and health outcomes. Given the significant burden of liver cirrhosis, restructuring healthcare services is crucial. Nurses' involvement in secondary prevention for other chronic diseases has shown benefits, including improved symptom control, reduced hospitalisations and enhanced HRQoL. However, the nursing role in liver disease management remains understudied. This mixed-methods study proposal with an embedded sequential design will assess the effectiveness of a nurse-led virtual liver cirrhosis clinic (NLVLCC) on QoL, self-efficacy, and health outcomes in 90 patients with alcohol-related cirrhosis (60 intervention, 30 control). Health outcomes include medication adherence, performance status, dietary adherence, alcohol intake, depression, anxiety, stress and 30-day readmission. Phase one will involve a randomised controlled trial, followed by narrative analysis in phase two. Data collection will utilize standardized and structured tools, including the Chronic Liver Disease Questionnaire, Self-Efficacy for Managing Chronic Disease 6-item Scale, MARS, Karnofsky Performance Scale, 24-hour dietary recall, AUDIT, DASS, and adherence logs. NLVLCC components include patient education, dietary counseling, brief alcohol de-addiction intervention, psychological support, medication adherence, physical activity guidance and regular virtual follow-ups.