Development and Expert Consensus of a Stage-Based, Needs-Oriented Non-Pharmacological Sleep Management Program for...

Sleep disturbance is common among liver transplant recipients and is associated with impaired daytime functioning, psychological distress, impaired post-transplant recovery, and reduced quality of life. However, sleep-related problems and care needs may change across the transplant trajectory, whereas existing non-pharmacological interventions have not been systematically structured to address these stage-specific needs. This study aimed to develop a stage-based, needs-oriented, non-pharmacological sleep management program for liver transplant recipients.

This methodological study comprised two phases. In Phase 1, a preliminary program was developed through a literature review, qualitative interviews with 13 dyads of liver transplant recipients and their primary caregivers, and research team discussions. These findings were integrated to identify stage-specific sleep-related needs and inform intervention selection and adaptation. In Phase 2, 16 experts in liver transplantation medicine and liver transplantation nursing, sleep medicine, and traditional Chinese medicine nursing participated in a two-round Delphi consultation to evaluate and refine the program.

Both Delphi rounds achieved 100% response rates, with expert authority coefficients of 0.89 and 0.91, respectively. Item importance ratings were high, variability decreased across rounds, and expert agreement was statistically significant across all three program levels. The final program comprised 3 primary components, 11 secondary components, and 29 tertiary items spanning the pre-transplant, postoperative, and early transitional stages. Components were classified as core, optional adjunctive, with a referral-informed management pathway incorporated when additional clinical assessment or specialist collaboration was required.

A structured, consensus-informed, stage-based, needs-oriented sleep management program was developed for liver transplant recipients. It aligns intervention components with stage-specific sleep-related needs, symptom severity, safety considerations, and transplant-specific care requirements, providing a framework for subsequent feasibility testing and controlled evaluation.