Structured psychological intervention based on Omaha system model for postoperative maxillofacial tumor patients

Abstract

BACKGROUND

Surgery for maxillofacial tumors frequently results in functional impairment and facial deformity, which can induce social withdrawal and disturbed body image. The Omaha system has not been used with this population, and conventional care does not provide systematic psychosocial assistance. Our hypothesis was that, in comparison to standard care, a structured Omaha system-based psychological intervention would improve quality of life while lowering social withdrawal and body image disturbance.

AIM

To evaluate the effect of Omaha system-based psychological intervention on body image and social withdrawal in maxillofacial tumor surgery patients.

METHODS

This retrospective study enrolled 120 patients after maxillofacial tumor surgery at Shanghai East Hospital (2023 to 2025), dividing them into control (n = 60) and observation (n = 60) groups. The observation group received 6-week Omaha system-based psychological intervention. Validated scales assessed anxiety, depression, body image, social withdrawal, self-management, and quality of life. Group comparisons used t-tests and χ² tests.

RESULTS

After intervention, the observation group showed significantly lower scores than controls in anxiety (42.90 ± 3.65 vs 45.08 ± 4.78, P = 0.006), depression (40.97 ± 4.11 vs 44.98 ± 4.33, P < 0.001), body image disturbance (33.35 ± 2.15 vs 35.67 ± 3.01, P < 0.001), social withdrawal (6.48 ± 2.38 vs 8.27 ± 2.86, P < 0.001), and social distress (7.00 ± 2.16 vs 8.60 ± 2.76, P = 0.001), while self-management and quality of life scores were significantly improved (P < 0.05).

CONCLUSION

Omaha system-based psychological intervention reduces body image disturbance and social withdrawal, and improves quality of life in post-maxillofacial tumor surgery patients.

Key Words: Omaha system; Structured psychological intervention; Maxillofacial tumors; Body image distress; Social withdrawal

Core Tip: This study is the first to use the Omaha system model for structured psychosocial support in patients after maxillofacial tumor surgery. In contrast to standard care, it uses interdisciplinary, focused interventions (cognitive restructuring, social skills training) to methodically address body image disorder and social avoidance. The innovation is in translating complete Omaha assessments into a reproducible, six-week regimen that concurrently improves psychological distress and health self-management, delivering a standardized, evidence-based nursing approach for disfigurement-related psychosocial sequelae.

INTRODUCTION

Surgical resection remains the primary treatment for maxillofacial tumors, which are frequently encountered in oral and maxillofacial surgery[1]. However, since the maxillofacial region has important aesthetic and social functions, surgery inevitably changes the patient’s facial appearance and may even lead to dysfunction in chewing, swallowing, and speech[2]. This change can easily cause patients to develop body image distress, that is, to have negative cognition and emotional reactions to their own image, manifested as excessive attention and dissatisfaction with their appearance, which in turn leads to negative emotions[3]. The continued existence of body image distress can lead to patients being prone to social withdrawal behavior[4]. Because of the fear of being looked at differently or negatively evaluated by others in social situations due to their appearance, patients actively reduce their social activities, which not only affects normal interpersonal relationships but may also gradually cause them to become disconnected from society, further increasing their psychological burden and reducing their quality of life[5,6]. Therefore, it is extremely important from a clinical standpoint to investigate a structured psychological intervention model that can effectively alleviate social withdrawal behavior and body image issue in patients following maxillofacial tumor surgery. Three elements make up the Omaha system, an established nursing framework focused on problem-solving: Problem categorization, assistance programs, and result evaluation[7]. The system conducts a structured assessment of patients from four dimensions: Environment, psychosocial, physiological, and health-related behaviors[8]. Compared with traditional psychological care, its theoretical advantage lies in viewing the body image distress of patients after maxillofacial tumor surgery as the result of multiple factors interacting. Physiological dysfunction (such as swallowing and speech limitations) exacerbates appearance anxiety, social phobia inhibits health behaviors (such as rehabilitation compliance), and lack of social support worsens the negative cycle. Based on this systematic problem analysis, the treatment plan can achieve an upgrade from single emotional relief to multidimensional behavioral reconstruction. Despite the system’s widespread usage in community nursing, chronic illness, and rehabilitation[9,10], little is known about how it might be used to body image distresss and social withdrawal following maxillofacial tumor surgery. Therefore, this study integrates the Omaha system with structured psychological intervention to develop a postoperative program for these patients, aiming to evaluate its effects on body image distress, social withdrawal, emotional state, health self-management, and quality of life, so as to provide a scientific reference for clinical nursing.

MATERIALS AND METHODS

General information

This study included 120 patients who underwent maxillofacial tumor surgery at Shanghai East Hospital between January 2023 and November 2025. They were divided into two groups according to their treatment plans: A control group (standard postoperative care, n = 60) and an observation group (standard postoperative care and systemic psychotherapy based on the Omaha system model, n = 60).

Inclusion criteria: (1) Must be at least eighteen years old; (2) Must have undergone surgery and meet the diagnostic criteria for maxillofacial tumors[11]; (3) Conscious and able to communicate normally; and (4) Signed an informed consent form after learning about the study.

Exclusion criteria: (1) Individuals with different types of cancer; (2) Individuals with mental illness; (3) Individuals with brain tumors or other organic brain lesions; and (4) Individuals who interrupted treatment or were transferred to another hospital.

Sample size description: This study was a retrospective design. The sample size was determined based on the actual number of maxillofacial tumor patients who met the inclusion criteria after surgery at Shanghai East Hospital between January 2023 and November 2025, with a final inclusion of 120 patients (60 in each group). Post-hoc power analysis showed that, with α = 0.05 and effect size d = 0.50, the current sample size (60 in each group) provided a statistical power of 0.82, which was sufficient to detect differences between groups in the primary outcome measures [Self-Rating Anxiety Scale (SAS); Self-Rating Depression Scale (SDS); Body Image Disturbance Questionnaire (BIDQ); Social Avoidance and Distress Scale (SADS)].

Methods individuals

within the control group underwent standard postoperative care for 6 weeks. Upon admission, patients received education to familiarize themselves with the hospital environment as quickly as possible. After the surgical treatment plan was determined, nursing staff assisted them in preoperative preparation and guided them through various examinations. Postoperatively, basic nursing interventions were implemented, including monitoring vital signs and wound care, providing medication guidance, educating them on complication prevention, providing dietary interventions, and administering drug treatment. Monitoring of the patient’s condition and prevention of complications were carried out to promote recovery. Health guidance was provided upon discharge. Routine psychological support was also provided throughout the nursing process, but no systematic psychological intervention was conducted. Along with the control group, the observation group also got structured psychological psychotherapy founded on the Omaha system model. The intervention period was 6 weeks. The specific implementation process was divided into three stages: Assessment, intervention and evaluation.

Assessment stage: A multidisciplinary intervention team consisting of 1 attending physician, 1 head nurse, 2 nurses trained in the Omaha system and 1 psychotherapist was formed. Before the intervention, the Omaha system problem classification table was used to systematically assess the patient in four areas: Environment, psychosocial, physiological and health-related behaviors. The team focused on identifying core issues such as the degree of body image distress, social withdrawal behavior, anxiety and depression, and health self-management ability, and established individualized nursing records.

Intervention implementation stage: Based on the assessment results, the Omaha system intervention program was adopted to formulate and implement targeted structured psychological intervention measures, including: Conducting health education, explaining to patients the reasons for postoperative facial changes, the recovery process and coping strategies, and correcting unreasonable perceptions of body image; implementing individualized psychological counseling and cognitive reconstruction to help patients accept changes in their own image and alleviate negative emotions; conducting social skills training, through role-playing, scenario simulation and other methods, to gradually reduce patients’ social withdrawal behavior and social distress; guiding patients to develop a health self-management plan, covering dietary conditioning, facial care, rehabilitation exercises and other content, to improve their health self-management ability; mobilizing family and social support, encouraging family members to participate in the intervention process, providing emotional support, and assisting patients in establishing positive social connections.

Evaluation stage: After the last intervention, the Omaha system outcome evaluation system was adopted, and the patient’s various indicators were comprehensively evaluated in combination with relevant scales, and the subsequent nursing plan was dynamically adjusted according to the evaluation results. The intervention in this study was implemented using a combination of face-to-face and online follow-up: The first two weeks of intervention were conducted face-to-face during the patient’s hospitalization, and the following four weeks involved outpatient continuity of care via video calls, WeChat voice messages, etc., twice a week for 45-60 minutes each time. All intervention procedures were performed by researchers who had received standardized training, and a standardized intervention manual was developed to ensure consistency in implementation.

Intervention quality control: To ensure the consistency and repeatability of the intervention implementation, the research team developed a standardized operating manual before the intervention began. The manual detailed the core content, procedures, key communication points, and time allocation for each intervention. All nursing staff (2 participants) and psychotherapist (1 participant) involved in the intervention implementation received two weeks of standardized training before the intervention began. The training included the Omaha systemic assessment method, cognitive restructuring techniques, and social skills training guidance techniques. Participants were assessed through role-playing and simulation exercises, and only those who passed the assessment were allowed to participate in the study. During the intervention, after each intervention, the interventionist filled out an intervention implementation record form, recording the core content of the intervention, the patient’s response, and the time spent. In addition, the research team held a case discussion meeting every two weeks to provide feedback and recalibrate any issues that arose during the intervention implementation.

Compliance recording: The research team established an intervention participation file for each patient in the observation group, recording attendance, participation duration, and the frequency of patient initiation of questions or interactions for each intervention, serving as a quantitative indicator of intervention compliance. “Compliance” was defined as completing all 12 interventions over 6 weeks (or completing ≥ 10 interventions, i.e., ≥ 83.3%), otherwise it was considered “non-compliance”. During the intervention, 4 patients dropped out in the observation group. Among them, 2 patients discontinued the intervention due to changes in their postoperative condition requiring transfer to another department, 1 patient voluntarily withdrew from the study for personal reasons, and 1 patient was excluded due to insufficient compliance because they failed to complete 80% of the required number of interventions (participating in only 5 interventions). A total of 60 patients were ultimately included in this study. In the control group, 1 patient was excluded due to prolonged hospitalization caused by postoperative wound infection. All 60 patients ultimately completed the full assessment.

Observation indicators general information: Baseline information of patients upon admission was collected, including age, sex, disease progression, tumor location, tumor type (benign/malignant), surgical procedure (simple resection/resection + flap repair), education level, marital status, and tumor-node-metastasis stage (for malignant cases only).

Anxiety and depression: Measured using the SAS[12] and the SDS[13]. Zung[12] created both scales, which had 20 elements each. A scale of 1 to 4 was used to score each item. The scales’ initial scores were standardized to range from 0 to 100. Anxiety or depression is more severe the higher the score. The Chinese versions of the SAS and SDS scales have been widely used in clinical research in China. In this study, the Cronbach’s α coefficients of SAS and SDS were 0.89 and 0.88, respectively, indicating good reliability.

Body image distress: Measured using the BIDQ[14], a seven-item tool developed by Cash et al[14]. The items cover behavioral avoidance, mental concerns, emotional discomfort, social/occupational/functional impairment, social life interference, other functional interference, and appearance-related distress. Higher scores indicate more serious body image problems. In this study, the Cronbach’s α coefficient for BIDQ was 0.86, indicating good reliability.

Social withdrawal and distress: The SADS[15] was used. This scale consists of 28 items covering two dimensions: Social avoidance and social distress. Higher scores indicate a stronger tendency to avoid social situations and greater social distress. In this study, the Cronbach’s α coefficient for SADS was 0.84, indicating good reliability.

Health self-management skills: Evaluated using the Assessment of Health Self-Management and Maintenance Rating Scale[16]. The scale includes 38 items across three dimensions: Self-management environment, self-management cognition, and self-management behavior. Higher scores represent stronger health self-management ability. In this study, the Cronbach’s α coefficient of Assessment of Health Self-Management and Maintenance Rating Scale was 0.87, indicating good reliability.

Quality of life: The Generic Quality of Life Inventory-74 was used[17]. This 74-item scale covers four dimensions: Physical function, psychological function, social function, and material life. Raw scores for each dimension are normalized and transformed to a 0~100 scale, and the overall score is also converted to 0~100. Higher scores indicate better quality of life. In this study, the Cronbach’s α coefficient of Generic Quality of Life Inventory-74 was 0.89, and the Cronbach’s α of each dimension ranged from 0.78 to 0.88.

Scale description: All scales used are publicly available Chinese versions. All scale assessments were conducted by two uniformly trained research nurses in a quiet, independent environment, using standardized instructions. Prior to the assessment, assessors received training on scale item interpretation, administration procedures, and consistency in scoring criteria; the Kappa value for inter-assessor consistency was > 0.80.

Statistical analysis

SPSS version 22.0 was used for all statistical analyses. Continuous data are presented as mean ± SD. Within-group and between-group comparisons were conducted using paired-samples and independent-samples t-tests, respectively. Categorical variables are expressed as n (%), with group differences assessed via the χ² test. A threshold of P < 0.05 defined statistical significance.

RESULTS

General information

There were no significant differences between the two groups of patients in terms of age, sex, disease duration, tumor location, tumor type, surgical method, education level, marital status, and clinical stage (malignant cases only) (P > 0.05), as shown in Table 1. After nursing intervention, all scores in both groups were significantly lower than before (P < 0.05). Furthermore, the SAS score (42.90 ± 3.65), SDS score (40.97 ± 4.11), and BIDQ score (33.35 ± 2.15) in the observation group were significantly lower than those in the control group (45.08 ± 4.78, 44.98 ± 4.33, 35.67 ± 3.01), with statistically significant differences between the groups (P < 0.05). This suggests that structured psychological intervention based on the Omaha systems Model can more effectively alleviate patients’ anxiety and depression, and improve body image distress (Table 2). After nursing intervention, the scores in both groups decreased significantly compared to before the intervention (P < 0.05). Specifically, the social withdrawal score (6.48 ± 2.38) and social distress score (7.00 ± 2.16) in the observation group were significantly lower than those in the control group (8.27 ± 2.86 and 8.60 ± 2.76, respectively), with statistically significant differences between the groups (P < 0.05). This indicates that structured psychological intervention helps reduce patients’ social withdrawal behavior and related distress experiences (Table 3). After nursing intervention, the scores of all dimensions in both groups were significantly improved compared with those before intervention (P < 0.05). Furthermore, the scores of the observation group in self-management environment (43.53 ± 3.07), self-management cognition (52.87 ± 3.25), and self-management behavior (51.43 ± 4.48) were significantly higher than those in the control group (37.00 ± 3.12, 47.83 ± 3.32, 49.73 ± 4.45), and the differences between the groups were statistically significant (P < 0.05). This indicates that this intervention model can more effectively improve patients’ health self-management ability (Table 4). After nursing intervention, the scores of both groups in all dimensions were significantly improved compared with those before intervention (P < 0.05). Furthermore, the observation group’s scores in physical function (71.60 ± 4.28), psychological function (75.63 ± 5.38), social function (73.43 ± 4.44), and material life (71.78 ± 4.35) were significantly higher than those in the control group (68.02 ± 6.66, 72.87 ± 6.42, 68.43 ± 4.24, 70.35 ± 3.05), with statistically significant differences between the groups (P < 0.05). This suggests that structured psychological intervention has a significant advantage in comprehensively improving patients’ quality of life (Table 5).

Table 1 General data, n (%)/, mean ± SD.

Group	Control group (n = 60)	Observation group (n = 60)	t/χ2	P value
Age (years)	45.48 ± 5.21	46.12 ± 5.90	0.624	0.534
Gender			0.307	0.580
Male	27 (45.00)	24 (40.00)
Female	33 (55.00)	36 (60.00)
Course of illness (months)	6.40 ± 1.99	6.57 ± 1.92	0.468	0.641
Location of tumor			1.496	0.683
Oral cavity	13 (21.67)	8 (13.34)
Salivary glands	21 (35.00)	24 (40.00)
Upper and lower jaws	18 (30.00)	20 (33.33)
Face and neck	8 (13.33)	8 (13.33)
Tumor type			0.135	0.713
Benign	28 (46.67)	26 (43.33)
Malignant	32 (53.33)	34 (56.67)
Surgical approach			0.300	0.584
Simple tumor resection	35 (58.33)	38 (63.33)
Resection + flap repair	25 (41.67)	22 (36.67)
Education level			0.543	0.461
Junior high school and below	28 (46.67)	24 (40.00)
High school and above	32 (53.33)	36 (60.00)
Marital status			0.786	0.375
Married	49 (81.67)	45 (75.00)
Unmarried/divorced/widowed	11 (18.33)	15 (25.00)
Clinical staging (malignant cases only)	n = 32	n = 34	0.120	0.729
Stage I-II	19 (59.38)	22 (64.71)
Stage III-IV	13 (40.62)	12 (35.29)

Table 2 Scores for body image distress with anxiety and depression, mean ± SD.

Group	Control group (n = 60)	Observation group (n = 60)	t	P value
SAS
Per-care	56.78 ±3.89	56.82 ± 4.14	0.045	0.964
Post-care	45.08 ± 4.78a	42.90 ± 3.65a	2.811	0.006
SDS
Per-care	58.93 ± 6.53	59.30 ± 8.62	0.263	0.793
Post-care	44.98 ± 4.33a	40.97 ± 4.11a	5.209	< 0.001
BIDQ
Per-care	39.97 ± 4.08	40.48 ± 3.90	0.709	0.480
Post-care	35.67 ± 3.01a	33.35 ± 2.15a	4.846	< 0.001

^aP < 0.05 vs per-care.

SAS: Self-Rating Anxiety Scale; SDS: Self-Rating Depression Scale; BIDQ: Body Image Disturbance Questionnaire.

Table 3 Social withdrawal and distress scores, mean ± SD.

Group	Control group (n = 60)	Observation group (n = 60)	t	P value
Social withdrawal
Per-care	10.47 ± 2.38	11.08 ± 2.17	1.148	0.141
Post-care	8.27 ± 2.86a	6.48 ± 2.38a	3.713	< 0.001
Social distress
Per-care	10.03 ± 2.34	10.10 ± 2.05	0.166	0.868
Post-care	8.60 ± 2.76a	7.00 ± 2.16a	3.532	0.001

^aP < 0.05 vs per-care.

Table 4 Health self-management ability scores, mean ± SD.

Group	Control group (n = 60)	Observation group (n = 60)	t	P value
Self-management environment
Per-care	30.03 ± 2.12	29.50 ± 2.22	1.345	0.181
Post-care	37.00 ± 3.12a	43.53 ± 3.07a	11.569	< 0.001
Self-management awareness
Per-care	41.68 ± 2.99	41.67 ± 2.78	0.032	0.975
Post-care	47.83 ± 3.32a	52.87 ± 3.25a	8.393	< 0.001
Self-management behavior
Per-care	42.20 ± 3.64	42.53 ± 3.28	0.527	0.599
Post-care	49.73 ± 4.45a	51.43 ± 4.48a	2.085	0.039

^aP < 0.05 vs per-care.

Table 5 Quality of life scores, mean ± SD.

Group	Control group (n = 60)	Observation group (n = 60)	t	P value
Somatic functions
Per-care	54.43 ± 5.75	54.83 ± 5.14	0.402	0.689
Post-care	68.02 ± 6.66a	71.60 ± 4.28a	3.507	0.001
Psychological function
Per-care	50.75 ± 5.11	51.07 ± 5.76	0.319	0.751
Post-care	72.87 ± 6.42a	75.63 ± 5.38a	2.557	0.012
Social function
Per-care	63.95 ± 4.21	63.85 ± 4.21	0.130	0.897
Post-care	68.43 ± 4.24a	73.43 ± 4.44a	6.303	< 0.001
Material life
Per-care	63.00 ± 4.03	62.75 ± 3.80	0.350	0.727
Post-care	70.35 ± 3.05a	71.78 ± 4.35a	2.088	0.039

^aP < 0.05 vs per-care.

DISCUSSION

The results of this study indicate that structured psychological intervention based on the Omaha system model can bring significant clinical benefits to the psychological rehabilitation of patients after maxillofacial tumor surgery. The core of the Omaha system lies in the structured assessment of patients’ health problems from four dimensions: Environment, psychosocial, physiological, and health-related behaviors, and the formulation of specific and measurable intervention strategies accordingly[18]. Unlike the passive response-based psychological support in routine postoperative care, the unique advantage of this system is that it integrates “assessment-intervention-evaluation” into a closed-loop process, ensuring that intervention measures are always based on the patient’s real needs rather than clinical experience and intuition. The multidisciplinary intervention team established in this study strictly followed this core logic, accurately identified the key targets of postoperative rehabilitation (including anxiety and depression, body image distress, social withdrawal behavior, and weak health self-management ability) through the four-dimensional assessment of the system, and formulated personalized nursing intervention plans based on this. The results showed that this targeted intervention can effectively alleviate patients’ negative emotions, significantly improve body image distress and social withdrawal behavior, and at the same time improve their health self-management ability and overall quality of life. In this study, the observation group scored significantly lower than the control group on BIDQ, SADS, suggesting that this intervention model can simultaneously improve appearance-related psychological distress and the resulting social dysfunction. Further analysis of the relationship between the two revealed a key logical chain: The essence of body image distress is negative cognition of appearance, while social withdrawal is its behavioral manifestation. When patients continuously hold catastrophic cognitions such as “appearance is unpleasant” and “others will reject me”, social scenarios trigger anticipatory anxiety, which in turn leads to avoidance behavior. The cognitive reconstruction intervention in this study helps patients identify and correct their catastrophic interpretation of appearance, breaking the erroneous cognitive chain of “appearance defect → negative evaluation → social danger”; while social skills training[19] provides low-risk behavioral experimental scenarios on this basis, allowing patients to gain corrective experiences in real interactions and transforming cognitive improvement into behavioral change. At the same time, the mobilization of family and social support also provides patients with safe emotional support and enhances their confidence in returning to social interaction, which is consistent with the research results of psychological intervention for breast cancer and burn patients[20,21]. The SAS and SDS scores of the observation group were significantly lower than those of the control group after the intervention, indicating that structured psychological intervention can also effectively reduce patients’ negative emotions. The mechanism may be due to the Omaha system’s comprehensive assessment of patients from a socio-psychological perspective[22], and the use of targeted measures such as cognitive reconstruction and psychological counseling to help patients adjust their negative self-image cognition[23]. Further analysis of the relationship between body image improvement and social reduction suggests that the relief of anxiety and depression may play a key mediating role in this process. Cognitive reconstruction first corrects patients’ negative automatic thinking about their appearance, thereby reducing the fear sensitivity activated in social expectations, and at the same time reducing the self-deprecation and hopelessness caused by appearance defects. Only when anxiety and depression drop below a certain threshold can patients have enough psychological energy to actively participate in social training and gradually reduce avoidance behavior in real scenarios. This hypothesis is consistent with the path of “cognitive behavioral therapy improving body image distress by reducing avoidance coping strategies” verified by Graboyes et al[24]. However, due to the limitations of this study design, the above causal chain has not yet been directly verified by statistics. Future research could use repeated measures mediation model to clarify the mediating effect size of emotional variables between the improvement of body image cognition and the recovery of social function. Regarding health self-management ability, the observation group scored significantly higher instead of the controlling group across all three aspects - self-managing environment, self-managing thinking, and self-managing behavior - demonstrating the positive behavioral impact of structured psychological intervention based on the Omaha system[25]. It is worth noting that the enhancement of the “self-managing behavior” dimension in this study was relatively limited compared with the cognition dimension, which may be related to the functional impairments such as chewing and swallowing in patients after maxillofacial tumor surgery. Li et al[26] pointed out that problems such as difficulty swallowing and limited mouth opening will affect the behavioral compliance of such patients in rehabilitation exercises; Graboyes and Barbon[27] also emphasized that the interaction between functional impairment and body image distress will weaken the patient’s self-management confidence. The above factors may jointly restrict the rapid change at the behavioral level, suggesting that further integration of adaptive behavioral guidance for functional impairment is needed in the future. In terms of quality of life, the observation group was significantly better than the control group in all four dimensions, suggesting that structured psychological intervention has a positive contribution to the overall quality of life of patients. However, as a composite outcome indicator, it should not be simply attributed to a single intervention. Its improvement may stem from the superposition effect of multiple pathways: At the physiological level, rehabilitation training alleviates functional impairment and reduces daily discomfort; at the psychological level, the decrease in anxiety and depression levels releases psychological resources and promotes social participation; at the social level, family support strategies provide emotional buffering and indirectly improve social function scores, which is consistent with the findings of Lin et al[28]. However, the difference between the groups in the material life dimension was only marginally significant (P = 0.039), which is consistent with the conclusion of Mady et al[29] on economic toxicity. The structural burdens such as long-term treatment costs and decreased labor capacity are difficult to eliminate through short-term nursing intervention. Obuekwe et al[30] also confirmed that social determinants are closely related to health outcomes. In summary, the improvement in quality of life is the result of the interaction of psychological, functional, social and economic factors. Future research can include the above variables for multivariate analysis to clarify the relative contributions of each factor. This study has several limitations. First, this study was a single-center retrospective design with a limited sample size, and the extrapolation of the conclusions requires validation through multicenter studies. Second, due to the nature of the intervention, blinding of patients and intervention providers was not possible, potentially leading to implementation bias. Third, subgroup analyses were not conducted for different tumor types, stages, and surgical methods, as these factors may influence patients’ body image distress and social adaptation levels. Fourth, a systematic comparison of baseline characteristics of dropout patients (4 in the observation group and 1 in the control group) was not performed, failing to completely rule out dropout bias. Fifth, the 6-week follow-up only reflects short-term effects; long-term efficacy requires verification through extended follow-up. Sixth, the independent contributions of confounding factors such as economic burden, family support, and functional recovery to quality of life were not assessed. Future research should incorporate the above variables for multivariate analysis and further validate the universality and sustained effectiveness of this intervention model through multicenter, large-sample, and long-term designs.

CONCLUSION

In conclusion, structured psychological intervention based on the Omaha systems Model, through systematic assessment, multidimensional intervention, and closed-loop evaluation, can effectively improve body image disturbances, social withdrawal behaviors, and negative emotions in patients after maxillofacial tumor surgery, thereby enhancing their health self-management abilities and quality of life. This intervention model has strong operability and promotional value, and further application in clinical nursing practice is recommended. It should be noted that the 6-week follow-up in this study only reflects short-term benefits, and the long-term effects need to be verified by extending the follow-up period.