Self‐efficacy beliefs mediate the relationship between subjective cognitive functioning and physical and mental well‐being after hematopoietic stem cell transplant

Abstract

Objective Cognitive problems are commonly reported by hematopoietic stem cell transplant (HSCT) survivors, and are associated with poorer physical and mental well-being. It was hypothesized that adverse effects of subjective cognitive impairment occur because cognitive difficulties reduce survivors’ confidence that they can manage HSCT-related symptoms—that is, self-efficacy for symptom management. Methods HSCT survivors (n = 245) 9-months to 3-years post-HSCT completed measures of subjective cognitive functioning, self-efficacy for symptom management, and clinically important outcomes: depressed mood, anxiety, and quality of life. Mediation analyses using bootstrapping were conducted to investigate whether effects of subjective cognitive impairment on these outcomes were mediated by self-efficacy for cognitive (SE-Cognitive), emotional (SE-Emotional), social (SE-Social), and physical (SE-Physical) symptom management. Results Self-efficacy mediated relations between subjective cognitive impairment and depressed mood (total indirect effect = −.0064 and 95% confidence interval [CI] −.0097 to −.0036), anxiety (total indirect effect = −.0045, CI −.0072 to −.0021), and quality of life (total indirect effect = .0952, CI .0901 to .2642). SE-Emotional was a unique mediator when the outcome was depressed mood and anxiety. SE-Social, SE-Physical and SE-Emotional were specific mediators when outcome was quality of life. Conclusions Findings support the conclusion that subjective cognitive impairment reduces HSCT survivors’ confidence in their ability to manage common post-HSCT symptoms, with implications for physical and mental well-being. Interventions that help enhance survivors’ self-efficacy are likely to benefit HSCT survivors who report subjective cognitive impairment.

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Relationships among symptoms, psychosocial factors, and health-related quality of life in hematopoietic stem cell transplant survivors

“…Our findings must be interpreted as associations rather than causal relationships. Third, there are other possible contributing factors such as cognitive functioning, self-efficacy, self-esteem and health behaviors that were not addressed (9, 14, 59). Finally, we proposed pathways that are theoretically sound and testable per the availability of the dataset.…”

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“…However, deficits in one or more cognitive areas remained for more than 40% of survivors [45]. Subjective cognitive impairment in transplant patients has been associated with a reduction in survivors' confidence that they can manage symptoms post-treatment, with potential impact on overall physical and mental health [46]. Thus, interventions to improve self-efficacy with regard to cognitive function and self-management may be particularly useful for these patients.…”