Refining Mishel's Reconceptualized Uncertainty in Illness Theory: Explaining the Development of Uncertainty in Chronic Illness.

Abstract

Background and Purpose: Mishel's Reconceptualized Uncertainty in Illness Theory describes the changed, more positive appraisal of uncertainty over time in a chronic disease. Therefore, Mishel referred to "probabilistic thinking" and "self-organization." The description of these concepts remained highly abstract, limiting the understanding of how change of uncertainty comes about. We aimed to elaborate on this gap and at refining the theory. Methods: We conducted a study consisting of three parts: (a) concept analyses of "probabilistic thinking" and "self-organization," (b) longitudinal qualitative study to investigate uncertainty experience over time, and (c) triangulation of (a) and (b) to develop theoretical propositions. Results: We developed five theoretical propositions in syllogistic form: (a) if persons experience uncertainty, they think probabilistically to assess the existentiality of potential consequences, (b) if they expect existential consequences, they experience uncertainty as a threat, (c) if the existentiality of uncertainty diminishes, then individuals accept uncertainty as an inherent part of illness, (d) if they accept uncertainty, they cognitively reframe it in a positive way in order to promote recovery, and (e) if persons reexperience uncertainty, they reassess the existentiality of potential consequences. Implications for Practice: We propose "health belief" as a mechanism driving "cognitive reframing" to explain the interrelation between uncertainty and a more positive experience. "Existential uncertainty" offers a new perspective on preventing a change in uncertainty experience. The new concepts can provide guidance to take measures to reduce existential uncertainty and promote health beliefs to change the experience of uncertainty from a negative to a more positive one.