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.


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Mishel, M. (2007). Uncertainty in illness. Journal of Nursing Scholarship, 20:4. Retrieved from: http://onlinelibrary.wiley.com/doi/10.1111/j.1547-5069.1988.tb00082.x/pdf
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