Factors associated with unmet psychological care needs and development of a Neuman systems model-based risk prediction model in patients with hepatocellular carcinoma.

Background: Patients with hepatocellular carcinoma (HCC) often face symptom distress, treatment decision-making, demands for family support, communication needs, and financial concerns during early hospitalization. This study examined factors associated with unmet psychological care needs and developed a risk prediction model, guided by the Neuman Systems Model, to support early nursing stratification. Methods: This single-center retrospective study included 345 adults with HCC admitted between January 2020 and December 2024. Unmet psychological care needs were defined as a score of ≥3 on any item in the psychological domain of the Chinese Supportive Care Needs Survey Short Form-34 (SCNS-SF34) within 24-48 h after admission. Candidate predictors were classified as intrapersonal, interpersonal, or extrapersonal stressors. After outcome stratification, the cohort was randomly divided into training and validation sets (7:3). Multiple imputation, least absolute shrinkage and selection operator (LASSO) selection across 20 imputed datasets, and multivariable logistic regression were used to develop the nomogram. Discrimination, calibration, decision curve analysis, bootstrap internal validation, and sensitivity analyses were evaluated. Results: Unmet psychological care needs were identified in 205 patients (59.4%). The final model retained pain numeric rating scale (NRS) score, sleep disturbance, Patient Health Questionnaire-9 (PHQ-9) score, Generalized Anxiety Disorder-7 (GAD-7) score, family support, cooperation in physician-patient communication, and perceived economic burden. Higher pain scores, sleep disturbance, higher depressive and anxiety symptom scores, poor family support, poor cooperation in physician-patient communication, and heavy perceived economic burden were independently associated with unmet psychological care needs. The areas under the receiver operating characteristic curves (AUCs) were 0.851 in the training set and 0.829 in the validation set; the bootstrap-corrected AUC was 0.836. Calibration-in-the-large, calibration slope, Brier scores, and decision curve analysis indicated acceptable apparent and internal-validation performance. Sensitivity analyses excluding PHQ-9 and GAD-7 and applying a stricter outcome definition showed consistent directions of association for the principal predictors. Conclusions: Unmet psychological care needs were common within 24-48 h after admission among patients with HCC. The internally validated nomogram may support early risk stratification, symptom management, psychosocial screening, family involvement, communication optimization, and referral to medical social work services. Independent external validation is required before routine clinical implementation.