Reconceptualization of the Uncertainty in Illness Theory

Mishel, Merle H.

doi:10.1111/j.1547-5069.1990.tb00225.x

Cited by 812 publications

(1,056 citation statements)

References 17 publications

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“…22 Mishel's theory of uncertainty in chronic illness 26 identified that transitions can bring personal or spiritual growth and result in a positive experience. Although an event may seem negative to a provider, the patient and or caregiver may experience new perspectives on life, death or existential reality.…”

Section: Discussionmentioning

confidence: 99%

The Future as a Series of Transitions: Qualitative Study of Heart Failure Patients and Their Informal Caregivers

et al. 2014

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BACKGROUND: Advance care planning often only focuses on written advance directives rather than on future goals important to patients and families. Heart failure has a particularly uncertain future with variable clinical trajectories. A better understanding of patient and family concerns about and perceptions of the future could improve advance care planning. OBJECTIVE: We aimed to identify how patients with heart failure and their informal (family) caregivers perceive their future. DESIGN: This was a cross-sectional study using qualitative methods. PARTICIPANTS: Thirty-three patients from an academic health care system with New York Heart Association class II-IV heart failure and 20 of their informal caregivers participated in the study. We used a purposive sampling strategy to include patients within a range of ages and health statuses. APPROACH: Participants were asked in individual, semistructured interviews: "When you think about what lies ahead, what comes to mind?" Qualitative analysis used an inductive approach. Early in the analysis, it became clear that participants' narratives about the future were described in terms of past transitions. This led us to use transition theory to further guide analysis. Transition theory describes how people restructure their reality and resolve uncertainty during change. KEY RESULTS: Patients and their caregivers talked about past and present transitions when asked about the future: "The present gets in the way of talking about the future." We identified four common pivotal transitions, including the shock of first being diagnosed with heart failure; learning to adjust to life with heart failure; reframing and taking back control of one's life; and understanding and accepting that death is inevitable. Concerns about the future were framed based on the most recent transition. CONCLUSIONS: Heart failure is a series of transitions according to patients and caregivers. By recognizing and educating patients about transitions, identifying transition-specific concerns, and supporting patients and caregivers through transitions, the process of planning for the future as part of advance care planning may be improved.

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Section: Discussionmentioning

confidence: 99%

The Future as a Series of Transitions: Qualitative Study of Heart Failure Patients and Their Informal Caregivers

et al. 2014

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“…Illnessrelated uncertainty has been associated with psychological distress in a variety of patient populations (24,39,46) and with lower quality of life in RA patients (47). Fortunately, illness-related uncertainty is modifiable through the use of interventions such as educational strategies, assistance to the individual in changing his or her appraisal of uncertainty, availability of supportive health care providers, and strengthening of the individual's sources of social support (24,48).…”

Section: Discussionmentioning

confidence: 99%

Predictors of psychosocial adjustment in systemic sclerosis

Moser

Clements

Brecht

et al. 1993

Arthritis & Rheumatism

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Objective. To determine predictors of psychosocial adjustment in patients with systemic sclerosis (SSc).Methods. We surveyed 94 patients with SSc. Age, sex, education level, marital status, work status, income, support group attendance, length of time since diagnosis, functional status, social support, illnessrelated uncertainty, and hardiness were examined as potential predictors of psychosocial adjustment. The reliability and validity of the instruments used to measure these variables have been established.ResuZts. Only education level, functional ability, illness-related uncertainty, hardiness, and social support were predictive of psychosocial adjustment. Education level and functional ability explained 14% of the variance in psychosocial adjustment, while illnessrelated uncertainty, hardiness, and social support increased the explained variance to 38 %.Conclusion. Although patients with relatively poorer psychosocial adjustment to illness have lower formal education levels and more functional disability, the majority of the explained variance in psychosocial

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“…Illness uncertainty -the inability to explain the cause of an illness, define an illness, or make predictions about future health 10,11 -can undermine health-related decision making and psychological adjustment. 12,13 Such barriers posed by illness uncertainty may increase patient motivation to learn more information from sequencing results.…”

Section: Introductionmentioning

confidence: 99%

Patient hopes for diagnostic genomic sequencing: roles of uncertainty and social status

et al. 2015

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For patients with unexplained or undiagnosed conditions, genomic sequencing offers the hope of resolving unanswered questions. With the growth of clinical genomic sequencing, understanding factors that shape patients' hope for information could have important implications for developing patient education guidelines. Based on the goal-directed theory of hope, we investigated illness uncertainty as a form of motivation and subjective social status as a form of perceived resources to predict the amount and kinds of information that adult patients (N = 191) and parents of pediatric patients (N = 79) hoped to receive from diagnostic sequencing results. Participants were part of a larger longitudinal study on clinical genomic sequencing, but the current study focuses on their hopes for diagnostic sequencing results. Hopes for information were assessed through close-ended and open-ended responses. Findings from mixed methods analyses indicated that although patients and parents hoped to learn multiple kinds of information from diagnostic sequencing results, their hopes appeared to be influenced by their illness uncertainty and perceptions of their social and economic resources. These findings suggest that patients' illness uncertainty and perceived resources could be useful avenues for discussing patient hopes and educating patients about strengths and limitations of genomic sequencing.

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Reconceptualization of the Uncertainty in Illness Theory

Cited by 812 publications

References 17 publications

The Future as a Series of Transitions: Qualitative Study of Heart Failure Patients and Their Informal Caregivers

The Future as a Series of Transitions: Qualitative Study of Heart Failure Patients and Their Informal Caregivers

Predictors of psychosocial adjustment in systemic sclerosis

Patient hopes for diagnostic genomic sequencing: roles of uncertainty and social status

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