Primary author: Eden Ewing_

The uncertainty in illness theory asserts that patients are unable to determine the meaning of illness related events, assign definite values to objects and events and/or accurately predict outcomes. It was originally posited by Merle Mishel to describe patients’ thought processes and mindsets throughout their health care experience. (Neville, 2003) Uncertainty isn’t necessarily a good or bad state; it depends on the implications that surround the uncertainty. It is defined as the inability to gather the meaning of a situation or event and it can develop if the patient doesn’t completely comprehend the gravity of the state of his or her illness. “The state of uncertainty may be the result of the nature of the stimulus…or the result of a deficiency in the perceiver such as a lack of a frame of reference for an event or because of limitations in current medical knowledge.” One of three things may happen when is something is perceived as uncertain: the event is unrecognized, the event it recognized by not classified, or it is recognized but not classified correctly. (Mishel, 1998)
The theory is further explicated when the constructs that precede uncertainty are examined. They include: stimuli frame, cognitive capacity and structure providers. The stimuli frame, which is the primary antecedent, is broken down further through symptom pattern, event familiarity and event congruence. These are influenced by the cognitive capacity of the patient (the ability of the patient to understand what is happening to them) and also by structure providers such as educational level, social support (friends and family) and credible authority (the amount of trust placed in healthcare providers). (Mishel, 2007)
In one study done by Wonghongul, Moore, Musil, Schneider & Deimling, (2000) women that survived breast cancer reported low levels of uncertainty and high levels of hope; they met their diagnosis as a challenge. To measure uncertainty in this study, as well as others, researchers use the Mishel Uncertainty in Illness Scale (MUIS) which is a 23 item instrument measured on a 5 point Likert scale. (Wonghungul, Moore, Musil, Schneider & Deimling, 2002) In another paper that examines the relationship of uncertainty in illness in childhood also used the MUIS scale. This study provided a review of literature that inspects how children react to being unsure of their treatment outcomes and options. It also provides an analysis of how families react to children being diagnosed and treated with not only life threatening diseases such as cancer, but also chronic diseases such as asthma. The review determined that low levels of certainty led to poor psychological outcomes but uncertainty was highest in parents, especially mothers, right after the realization that something is wrong but before a definitive diagnosis was made. Although some families report that this is the most stressful period, uncertainty still pops up during treatment and even after treatment ends. Some families report that they have a more positive outlook on life after dealing with a period of uncertainty. (Stewart&Mishel, 2000)
According to a paper written by McCormick (2002) high uncertainty in illness can lead to anxiety and confusion. But it can also lead to opportunities for good outcomes. For some who have an external locus of control and place faith in God or a higher power, uncertainty may not be a negative. Mishel suggested that those with an external locus of control with no faith in a higher power might feel a little helpless while those with an internal locus of control might feel as if this uncertainty is an opportunity. (Sumner, 2002)
It's unclear if anyone can "control" uncertainty, but what the breast cancer study, among others, suggest is that the better educated a patient is about his or her possible outcomes, the less uncertainty they experienced. I believe public health workers should facilitate in patient education.

McCormick, K M (Summer 2002). A concept analysis of uncertainty in Illness. (Clinical Scholarship). Journal of Nursing Scholarship, 34, 2. 127. Retrieved : from Academic OneFile via Gale: rGroupName=iuib_iupui
Mishel, M. (2007). Uncertainty in illness. Journal of Nursing Scholarship, 20:4. Retrieved from:
Mishel M., Padilla, G., Grant, M., & Sorenson, D. (1991). Uncertainty in illness theory replication of the mediating effects of mastery and coping. Journal of Nursing Research, 40:4, 236-240. Retrieved from: 3.2.4b/ovidweb.cgi?WebLinkFrameset=1&S=FACJFPIBAEDDFDPDNCDLGGJCMB LAA00& 3.2.4b%2fovidweb.cgi%3fMain%2bSearch%2bPage%3d1%26S%3dFACJFPIBAEDD DPDNCDLGGJCMBELAA00& pdfs%2fFPDDNCJCGGPDAE00%2ffs047%2fovft%2flive%2fgv038%2f00006199%2f 0006199-199107000 00013.pdf&filename=Uncertainty+in+Illness+Theory%3a+A+Replication+of+the+Med ating+Effects+of+Mastery+and+Coping.&|1&pdf_key=FPDDNCJCGGPDAE00&pdf_index=/fs047/ovft/live/gv038/0 006199/00006199-199107000-00013&|1|sl_10|resultSet||0
Neville, K. (2003). Uncertainty in illness: an integrative review. Orthopaedic Review, 22:3, 206 214. Retrieved from: 3.2.4b/ovidweb.cgi?QS2=434f4e1a73d37e8c504983e01e46c99abe60b9a947a25a97ee3 8d37865f2a576caeb3b141d322d94d628611203319179eec20b35a9384a27163afa6f1796 b2023fa4f528a283aaa27cd8cb97c6f8a4355f643d97e6dba34b950cfb665e0131faea4d08 0167ddb51606c3b90f781128a68d7df4629247ebab54c8912c9673db4e4888c35e9a7aa00 5dc2b69faa962d6e945371dd809546aefea6ab5f87775f2c88a658858c2727c262f4f8d45d 5499fa4bbf696ed7e3fe5f6446bd73e91b21c2f9a15c9ce88e08d2cff52b4b0fe00696525f1 47cbb3ecfb2684a46c3548980545a62a5d2cab3266eef31c11587eaf5673b5eb6bbdcee3ab 3f583a481896f9f18227645e795e8dfb76206fa2431c2902af0ff7f2a350af977f2b05e9bb4 8a1d82581130ae931324380325e8b54bf65a7b86e2790179d6f8960c1508c37477b7c1d0 80408e9b0b9d7940767ff03efe20dc6a3a06bf60c9c584c7208ef756498c0e7be52810ad63 2db7fbbffefde3d0e97c4370ff02576574077b1a514d9d6a37db0e285dab439f9a11ecb44f d817dce552f446f319488607a048cf2
Stewart, J., & Mishel, M.. (2000). Uncertainty in Childhood Illness: A Synthesis of the Parent and ChildLiterature. Scholarly Inquiry for Nursing Practice, 14(4), 299-301,304-319. Retrieved October 31, 2010, from ProQuest Health and Medical Complete. (Document ID: 1472209771).
Wonghungkul, T., Moore, S., Musil, C., Schneider, S., & Deimling, G. (200). The influence of uncertainty in illness, stress appraisal and hope in coping in survivors of breast cancer. Cancer Nursing, 23:6, 422-429. Retrieved from: 3.2.4b/ovidweb.cgi?QS2=434f4e1a73d37e8c1650030b04b800f6e7c046d03e900ed4619 7b1b407b64c6a978004aaf071be5a093c1be7f945fecf47eda933df9dd562a505d8d474130 2d529db0d0841f0f0a0f1a58f15aeb3e36c4299eaddc1348434bd4e6178255b97e461cc4ee a3a03d333fb0fb5ae27a38e5661ba789ba226ed956abc9d8b84d3ff30084e0bb3ecefc7533 3ee2ff979c18408832aa0ec2ba10810b83dd1f59576e1aa378cc276b88487d9082b369166 3cab697b68cbdbbee6d44a34df77950824f12ca86758571249e3be73ea54198cf86ee7567 3622060a9ed1831a96ca2d5b569b4e3e88a6f4de1f12b73a6c0d55227c5ccf97808a325ab 9359267c4c96c10e4d2f358f58b1c366290b4cdc145db46bd54df1682230682a9da2b772b cb2371fae538ffbe79bef3304fb6ee09485baaebc01258cd8ad8f643dc642eec593d984b4b 3ad13dcff6157992a33ff6e844e1c2eeb534c18a1b65f2299cc7e4a0c9815267ba7620380b 0a3b10ddb398f935cac7a40a1c0ed16e9c527c8ca49a12cbf3c3d726259a5c0e791547527 71598b9778d32de22911ce52084fd6a4d262ff54311ad9f80ec174d766a678133ec4bac05 99b0a746160958b6bfa3ff35e