title: Holding back moderates the association between health symptoms and social well-being in patients undergoing hematopoietic stem cell transplantation.
abstract: BACKGROUND
  Holding back, or withholding discussion of disease-related thoughts and emotions, is associated with negative outcomes including lower quality of life, diminished well-being, and relational distress. For patients undergoing hematopoietic stem cell transplantation (HSCT), the degree to which one holds back from discussing illness-related concerns may be an important determinant of social well-being and health; however, this has not been systematically assessed in this population.
  
  
  OBJECTIVE
  The purpose of the present study was to assess the moderating effects of holding back discussion of disease-related concerns on the relationship between health-related symptoms and social well-being in adult patients undergoing HSCT.
  
  
  METHODS
  Seventy autologous (n = 55) and allogeneic (n = 15) HSCT patients completed measures of holding back, social well-being, and health symptoms (i.e., pain, fatigue, sleep problems, cognitive problems) both before and after transplantation (i.e., three months after transplantation and six months after transplantation).
  
  
  RESULTS
  In patients with average to high levels of holding back, health symptoms were significantly related to lower levels of social well-being; however, for patients with low levels of holding back, the relationship between health symptoms and social well-being was not significant.
  
  
  CONCLUSIONS
  The results of the present study suggest that the level of holding back may be important in understanding how health-related symptoms relate to social well-being in patients undergoing HSCT. These findings underscore the importance of addressing how patients undergoing HSCT communicate about their disease with others as this may be related to their adjustment to illness and treatment.
authors: Pain Research and Intervention Center of Excellence, University of Florida College of Dentistry, Gainesville, Florida, USA.
authors: Emily J
authors: EJ
authors: Bartley
authors: Duke University Medical Center, Durham, North Carolina, USA.
authors: Sara N
authors: SN
authors: Edmond
authors: Duke University Medical Center, Durham, North Carolina, USA.
authors: Anava A
authors: AA
authors: Wren
authors: Duke University Medical Center, Durham, North Carolina, USA.
authors: Tamara J
authors: TJ
authors: Somers
authors: University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
authors: Irene
authors: I
authors: Teo
authors: Duke University Medical Center, Durham, North Carolina, USA.
authors: Sicong
authors: S
authors: Zhou
authors: Duke University Medical Center, Durham, North Carolina, USA.
authors: Krista A
authors: KA
authors: Rowe
authors: Duke University Medical Center, Durham, North Carolina, USA.
authors: Amy P
authors: AP
authors: Abernethy
authors: Duke University Medical Center, Durham, North Carolina, USA.
authors: Francis J
authors: FJ
authors: Keefe
authors: Duke University Medical Center, Durham, North Carolina, USA. Electronic address: rebecca.shelby@duke.edu.
authors: Rebecca A
authors: RA
authors: Shelby
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: HSCT; Hematopoietic stem cell transplantation; cancer; cognitive problems; emotional disclosure; fatigue; holding back; pain; sleep problems; social well-being