Uncertainty In Illness Theory Research Articles

Infertility as Seen through the Lens of Uncertainty in Illness Theory

Infertility affects approximately 10% to 20% of the childbearing age population worldwide. As infertility affects people from all socioeconomic levels and cuts across all racial, ethnic and religious lines, it is a community health problem of significant import. Infertile women report their infertility to be the worst crisis of their lives, experienced as more significant than divorce or the loss of a parent. Yet, it is a condition that is coped with largely in secret among couples and their health care providers. The inability to have children threatens the very essence of some people's being and self-worth in their family and society. Most research on infertility has been based on theories of stress and coping, but has neglected the concept of uncertainty, which has been shown to significantly affect the infertility experience. The purpose of this paper is to provide a theoretical context for the study of infertility, and to offer partial explanation for what may be driving advanced reproductive technology choices among infertile couples. Mishel's Theory of Uncertainty in Illness, a functional theory that has been used across health care disciplines is applied to infertility. A conceptual model of the theory is presented, explained and critiqued for its usefulness in understanding the lived experience of infertility. Understanding the role of uncertainty offers important implications for care providers, researchers and their infertile clients.

Quality of Life, Uncertainty, and Perceived Involvement in Decision Making in Patients With Head and Neck Cancer

To explore the relationship among perceived involvement in decision making, uncertainty, and quality of life (QOL) in patients with head and neck cancer in pre- and post-treatment periods using Mishel's Uncertainty in Illness Theory. A prospective, correlational design. Six outpatient clinics at urban hospitals in New York, NY. A convenience sample of 52 adults newly diagnosed with head and neck cancer. Data were collected by a self-administered questionnaire containing a demographic datasheet, the Functional Assessment of Cancer Therapy-Head and Neck, Mishel Uncertainty in Illness Scale (Adult), and Perceived Involvement in Care Scale, at pretreatment (Time 1) and six weeks post-treatment (Time 2). QOL, uncertainty, perceived involvement in decision making. Post-treatment QOL was lower than pretreatment. QOL was associated with uncertainty and employment status at Time 1 and Time 2. Uncertainty and QOL at the time of pretreatment were predictors of post-treatment QOL after controlling for unemployment, chemoradiation, and physician. Perceived involvement in decision making was not associated with uncertainty or QOL. The higher a patient's pretreatment QOL, the more likely QOL remains sound after treatment. Additional studies, including interventional evaluations to decrease uncertainty and to maintain employment and better income, are needed. Antecedents of Mishel's Uncertainty in Illness Theory may need to be refined for patients with head and neck cancer.

혈액투석 환자가 지각하는 불확실성과 사회적 지지가 안녕감에 미치는 영향

Purpose: The purpose of this study was to explore factors affecting uncertainty and general well-being based on Uncertainty in Illness Theory. Methods: Data were collected from 125 outpatients who had received hemodialysis. The path model among four concepts, such as period of hemodialysis, social support, uncertainty, and general well-being, was tested. Tangible support, positive social interaction, affectionate, and emotional/informational support were measured as social support. Adaptation in the model was operationalized as general well-being which consisted of anxiety, depression, positive well-being, self-control, and general health. Results: All paths were statistically significant at the level of <TEX>${\alpha}$</TEX>=.05. The significant paths were the path from period of hemodialysis to uncertainty (t=-2.86), social support to uncertainty (t=-2.01), uncertainty to general wellbeing (t=-2.85), and social support to general well-being (t=3.55). Conclusion: Patients who perceived low uncertainty and high social support were likely to feel well-being. Therefore, nurses should give patients appropriate information according to their needs and have meaningful interaction with patients to reduce their uncertainty and render social support.

Sentimentos das mães de crianças com paralisia cerebral à luz da teoria de Mishel

As crianças com paralisia cerebral sofrem com as consequências da lesão ao cérebro, apresentando dificuldades que afetam as atividades da vida diária. A família, principalmente a mãe, deve receber apoio dos profissionais para enfrentar o problema. Este estudo objetivou analisar a incerteza das mães quanto à doença de seus filhos com base na Teoria da Incerteza na Doença de Mishel. É um estudo descritivo e qualitativo, realizado em duas instituições públicas especializadas em distúrbios neuromotor da cidade Fortaleza, nos meses de julho e agosto de 2009. Foram entrevistadas 12 mães de crianças com paralisia cerebral por meio de um formulário com as variáveis sócio-econômico-sanitário-demográficas e um roteiro de entrevista semiestruturado baseado na Teoria de Mishel, na versão pais/filhos. Constatamos que as mães apresentam muitas incertezas, principalmente quanto ao futuro da criança. Tais incertezas podem ser reduzidas mediante apoio e orientação dos profissionais de saúde, melhorando, assim, a qualidade de vida de todos os envolvidos.

The relationships of social support, uncertainty, self‐efficacy, and commitment to prenatal psychosocial adaptation

To report a study of the relations of prenatal psychosocial adaptation, social support, demographic and obstetric characteristics, uncertainty, information-seeking behaviour, motherhood normalization, self-efficacy, and commitment to pregnancy. Prenatal psychosocial assessment is recommended to identify psychosocial risk factors early to prevent psychiatric morbidities of mothers and children. However, knowledge on psychosocial adaptation and its explanatory variables is inconclusive. This study was non-experimental, with a cross-sectional, correlational, prospective design. The study investigated Hong Kong Chinese women during late pregnancy. Convenience sampling methods were used, with 550 women recruited from the low-risk clinics of three public hospitals. Data was collected between January-April 2007. A self-reported questionnaire was used, consisting of a number of measurements derived from an integrated framework of the Life Transition Theory and Theory of Uncertainty in Illness. Explanatory variables of psychosocial adaptation were identified using a structural equation modelling programme. The four explanatory variables of the psychosocial adaptation were social support, uncertainty, self-efficacy, and commitment to pregnancy. In the established model, which had good fit indices, greater psychosocial adaptation was associated with higher social support, higher self-efficacy, higher commitment to pregnancy, and lower uncertainty. The findings give clinicians and midwives guidance in the aspects to focus on when providing psychosocial assessment in routine prenatal screening. Since there are insufficient reliable screening tools to assist that assessment, midwives should receive adequate training, and effective screening instruments have to be identified. The explanatory role of uncertainty found in this study should encourage inquiries into the relationship between uncertainty and psychosocial adaptation in pregnancy.

Using the Precede–Proceed Model of Health Program Planning in breast cancer nursing research

In this article, we discuss the use of the Precede-Proceed model when investigating health promotion options for breast cancer survivors. Adherence to recommended health behaviours can optimize well-being after cancer treatment. Guided by the Precede-Proceed approach, we studied the behaviours of breast cancer survivors in our health service area. The interview data from the cohort of breast cancer survivors are used in this article to illustrate the use of Precede-Proceed in this nursing research context. Interview data were collected from June to December 2009. We also searched Medline, CINAHL, PsychInfo and PsychExtra up to 2010 for relevant literature in the English language to interrogate the data from other theoretical perspectives. The Precede-Proceed model is theoretically complex. The deductive analytic process guided by the model usefully explained some of the health behaviours of cancer survivors, although it could not explicate many other findings. A complementary inductive approach to the analysis and subsequent interpretation by way of Uncertainty in Illness Theory and other psychosocial perspectives provided a comprehensive account of the qualitative data that resulted in contextually relevant recommendations for nursing practice. Nursing researchers using Precede-Proceed should maintain theoretical flexibility when interpreting qualitative data. Perspectives not embedded in the model might need to be considered to ensure that the data are analysed in a contextually relevant way. Precede-Proceed provides a robust framework for nursing researchers investigating health promotion in cancer survivors; however, additional theoretical lenses to those embedded in the model can enhance data interpretation.

Exploring the Palliative Care Needs of People Living in Thailand With End-Stage Renal Disease

This article describes the results of a pilot study that was undertaken as a needs assessment for the development of a home-based palliative care model for people living with end-stage renal disease (ESRD) in Thailand. Using the theory of uncertainty in illness as a guide, this mixed-methods study explored the palliative care needs of individuals with ESRD in Bangkok, Thailand. The study included 30 participants with ESRD, 39 family members, four community leaders, and four healthcare providers. The participants completed the revised Edmonton Symptom Assessment Scale, which provided descriptive data on nine symptoms commonly experienced among palliative care patients. In addition, focus group and in-person interviews were conducted with study participants. Four major themes emerged from the qualitative interviews that were congruent with the uncertainty in illness constructs: tremendous suffering, economic consequences, inadequate community support, and concern for the future. The participants suggested improvements in palliative home care from their unique cultural and spiritual perspectives. These findings will facilitate the development of a future intervention study that will examine the impact of a palliative care program for Thai persons living with ESRD.

Exploring Uncertainty in Advance Care Planning in African Americans

African Americans over 65 represent 3.5 of the 35.6 million Americans. Morbidity and mortality rates are highest among this group; associated with lack of resources and awareness of health problems. But health needs are the same at end of life, yet care is less than optimal. African Americans are less likely to have advance directives nonetheless desire communication, information, respect, and a trusting doctor-patient relationship. Low health literacy may contribute to this disparity. This scholarly review examines the health literacy in advance care planning and refines concepts of uncertainty in illness theory deriving a model for advance care planning in African Americans.

The relationships between uncertainty and its antecedents in Korean patients with atrial fibrillation

The aim of the study was to examine the relationships between uncertainty and its antecedents, including education, social support and symptom frequency in Korean patients with atrial fibrillation. The antecedents of uncertainty were theoretically identified from Mishel's theory of uncertainty in illness. There is a need to examine empirically whether theoretically driven antecedents of uncertainty work in a way that the theory proposed. Descriptive correlational and cross-sectional survey design. Subjects were interviewed using structured study questionnaires. The data collected were statistically analysed by descriptive statistics and hierarchical regression analysis to determine the effects of antecedents on uncertainty. A convenience sample of 109 subjects recruited from three academic medical centres in South Korea. The overall model significantly explained 20·1% of the variance in uncertainty. Among antecedents of uncertainty, social support was significantly associated with less uncertainty (β = -0·26), while the education was not associated with uncertainty. Persons with greater social supports perceived less uncertainty, and individuals with greater symptom frequency reported greater uncertainty (β = 0·21). In Korean patients with atrial fibrillation, it was demonstrated that uncertainty in atrial fibrillation patients was predicted by social support and symptom frequency. Thus, the nursing strategies that reduce uncertainty which results in undesirable outcomes are required through maximising the social support patients perceived and minimising the symptom frequency. Therefore, these findings are relevant to clinical nurses who take care of patients with atrial fibrillation in terms of decreasing uncertainty that might result in patients' psychological distress. Relevance to clinical practice. The findings from this study may be beneficial for clinical nurses to understand and assess the psychosocial and emotional needs of patients with atrial fibrillation.

Test of a conceptual model of uncertainty in children and adolescents with cancer

Despite recognition as a significant stressor in childhood cancer, illness-related uncertainty from the perspective of children remains under-studied. We tested a conceptual model of uncertainty, derived from Mishel's uncertainty in illness theory, in 68 school-aged children and adolescents with cancer. As hypothesized, uncertainty was significantly related to psychological distress, but only one hypothesized antecedent (parental uncertainty) significantly predicted children's uncertainty. An alternative model incorporating antecedent developmental factors (age and illness-specific expertise) explained 21% of the variance in child uncertainty; controlling for stage of treatment, uncertainty was higher in children with shorter time since diagnosis, older age, lower cancer knowledge, and higher parental uncertainty. These findings provide the foundation for further studies to understand children's management of uncertainty and its contribution to psychological adjustment to illness.

Understanding a meningioma diagnosis using Mishel's theory of uncertainty in illness

Uncertainty is probably the most certain thing a patient will experience when diagnosed with a potentially life-threatening illness. The diagnosis of a meningioma is no exception. The frequently benign, subtle, insidious growth of this tumor before diagnosis contributes to its uncertainty. The purpose of this article is to explore Mishel's theory of uncertainty in illness as it applies to a meningioma diagnosis. The implications of this theory for nursing practice will be considered. It is argued that an understanding of patients' response to the uncertainty surrounding a diagnosis of meningioma can help nurses offer women support to make more informed decisions about treatment options and subsequent interventions.

When the Cystic Fibrosis Label Does Not Fit: A Modified Uncertainty Theory

In this grounded, dimensional analysis we describe the experiences of five couples whose infants had equivocal diagnostic test results following positive genetic newborn screens for cystic fibrosis. We analyzed interview data collected at two points during each infant's first year. Uncertainty emerged as the central thematic dimension. Results showed that parents passed through a series of stages similar to the process described in Mishel's Uncertainty in Illness Theory (UIT), thus extending the application of the theory to circumstances in which the very presence of an illness is uncertain. Findings informed a modified version of the UIT comprised of five domains: stimuli frame, degree of uncertainty, opportunity- danger continuum, affective responses, and coping. This model incorporates Morse's conception of suffering. Three contextual domains influenced parents' experiences at various junctures along the uncertainty trajectory: individual characteristics, structure providers, and time. We discuss implications of the model for future research and clinical practice relative to genetic testing.

Managing uncertainty about treatment decision making in early stage prostate cancer: A randomized clinical trial

Objective The purpose of this study was to examine the effects of a theory-based decision-making uncertainty management intervention (DMUMI) providing newly diagnosed prostate cancer patients with information, communication skills and personally designed prompts. Methods A randomized clinical trial was conducted using a 3 × 2 design with intervention and control groups including both Caucasian and African-American men. General linear mixed models were used to compare intervention groups over time. Results Significant main effects for the treatment groups were found for uncertainty management (cancer knowledge, problem-solving, and patient–provider communication), medical communication competence, number and helpfulness of resources for information, and decisional regret. Conclusion The intervention was effective in uncertainty management for Caucasian and African-American men, specifically in preparing competent patients with improved knowledge, problem-solving skills, information resources, and communication skills. Using the Uncertainty in Illness Theory, specific skills were selected with a focus on the antecedents of uncertainty. Practice implications In the treatment decision-making context, patients and supportive others need information about disease, treatment options and side effects but they also need communication skills training prior to the treatment decision consultation.

A Model Linking Uncertainty, Post-Traumatic Stress, and Health Behaviors in Childhood Cancer Survivors

To consolidate the literature and provide a model to explain the links among uncertainty, post-traumatic stress syndrome, and health behaviors in adolescent and young adult childhood cancer survivors. A systemic review of related literature and theory was used for the proposed model. The literature pertaining to the Uncertainty in Illness Theory, childhood cancer late effects, post-traumatic stress, and health behaviors was reviewed and critiqued from three data sets from 1979-2007: MEDLINE, PsycInfo, and CINAHL. Key words used for the search were uncertainty and post-traumatic stress as well as health behaviors, including smoking, alcohol use, unsafe sex, sunscreen use, and physical inactivity. Childhood cancer survivors living with chronic uncertainty may develop a new view of life and, as a result, adopt more health-promotion behaviors and engage in less health-risk behaviors. However, survivors living with chronic uncertainty may generate symptoms similar to post-traumatic stress disorder and, therefore, adopt fewer health-promotion behaviors and engage in more health-risk behaviors. The uncertainty that pervades the childhood cancer experience can lead to the development of symptoms that resemble those of post-traumatic stress. The symptoms can interfere with the adoption of healthy lifestyle behaviors and avoidance of health-risk behaviors. The theoretically derived model outlined in this article can be used to guide clinical interventions and additional research into the health behaviors of childhood cancer survivors.

Uncertainty After Treatment for Prostate Cancer: Definition, Assessment, and Management

Prostate cancer is the second most common type of cancer in men living in the United States and the most common type of malignancy in Canadian men, accounting for 186,320 new cases in the United States and 24,700 in Canada in 2008. Uncertainty, a component of all illness experiences, influences how men perceive the processes of treatment and adaptation. The Reconceptualized Uncertainty in Illness Theory explains the chronic nature of uncertainty in cancer survivorship by describing a shift from an emergent acute phase of uncertainty in survivors to a new level of uncertainty that is no longer acute and becomes a part of daily life. Proper assessment of certainty and uncertainty may allow nurses to maximize the effectiveness of patient-provider communication, cognitive reframing, and problem-solving interventions to reduce uncertainty after cancer treatment.

Communication with Breast Cancer Survivors

Breast cancer survivors must manage chronic side effects of original treatment. To manage these symptoms, communication must include both biomedical and contextual lifestyle factors. Sixty breast cancer survivors and 6 providers were recruited to test a conceptual model developed from uncertainty in illness theory and the dimensions of a patient-centered relationship. Visits were audio-taped, then coded using the Measure of Patient-Centered Communication (Brown, Stewart, & Ryan, 2001). Consultations were found to be 52% patient-centered. Chi-square Automatic Interaction Detection (CHAID) analysis showed that survivor self-reported fatigue level and conversation about symptoms were associated with survivor uncertainty, mood state, and survivor perception of patient-centered communication. Survivors may want to discuss persistent symptom concerns with providers, due to concerns about recurrence, and discuss lifestyle contextual concerns with others.

The Relationships Between Uncertainty and Posttraumatic Stress in Survivors of Childhood Cancer

The purposes of this study were to understand the levels of uncertainty and posttraumatic stress and to examine their relationships in young adult survivors of childhood cancer. A cross-sectional correlational design was used in this study. Mailed survey was the data collection method. The Mishel Uncertainty in Illness Scale-Community Form was the measure of uncertainty. The University of California at Los Angeles Post Traumatic Stress Disorder Index was the measure of posttraumatic stress. A total of 46 (51.1%) survivors responded to the survey and the analysis was based on data from 45. Participants reported a mean 51.3 (SD = 14.5, range = 23 to 90) level of uncertainty; and a mean 15.7 (SD = 11.0, range = 0 to 43) level of posttraumatic stress. Uncertainty was positively correlated with posttraumatic stress (r = .40, p = .039). The re- conceptualization of the Uncertainty in Illness Theory (UIT) and developmental perspectives can explain the relationships between uncertainty and posttraumatic stress in the young adult survivors of childhood cancer. The re-conceptualization of UIT can serve as a guide for future studies.

Uncertainty, symptom distress, anxiety, and functional status in patients awaiting coronary artery bypass surgery

The study's objective was to (1) describe uncertainty, anxiety, the symptom distress experience, and functional status of patients on a coronary artery bypass graft (CABG) waiting list and express the relationship between these concepts; (2) explore whether length of time waited has an influence on the psychosomatic condition of patients; and (3) explore the use of semistructured interviews within the context of a theoretic framework and compare open-ended responses to quantitative results. A descriptive, correlational, cross-sectional design was used with supplementary telephone interviews using semistructured questions. Quantitative data were collected with a mailed questionnaire. Study instruments included the Mishel Uncertainty in Illness Scale (Community), Symptom Frequency and Symptom Distress Scale, Graphical Anxiety Rating Scale, and Kansas City Cardiomyopathy Questionnaire (Physical and Social Limitation). The Mishel Uncertainty in Illness Theory was used as the guiding theoretic framework. The study took place in one large tertiary care hospital in Winnipeg, Manitoba, Canada. The study included a convenience sample of 42 patients undergoing first-time elective CABG only, 25 of whom participated in the telephone interview. Average uncertainty and anxiety were present at moderate levels and were associated with moderate deterioration of functional status. Reported symptom distress was low; however, presence of symptoms showed a strong relationship with anxiety (P=.0002), and this relationship was confirmed through semistructured interviews. Although the relationship between uncertainty and anxiety was nonsignificant, the interviews suggest positive views of uncertainty as an opportunity may have muted the relationship between uncertainty and anxiety, and that it is possible to experience uncertainty as a danger and an opportunity simultaneously. No statistically significant relationship was found between the study variables and waiting time; however, there was a nonsignificant trend toward deterioration of psychologic and physical condition with longer waits, which may be clinically significant. Psychosocial distress and physical condition among patients on CABG waiting lists should be continually assessed in all patients regardless of how long they have been waiting. Each patient will have a unique presentation of symptoms and a corresponding unique psychologic response.

Uncertainty and its antecedents in patients with atrial fibrillation.

The aim of this descriptive, correlational, and cross-sectional survey was to explore uncertainty in patients with atrial fibrillation and to examine the relationships between uncertainty and its antecedents, including education, social support, and perceived seriousness of illness in patients newly diagnosed with atrial fibrillation. The theoretical framework of the study was Mishel's middle-range nursing theory of uncertainty in illness. A convenience sample of 81 participants recruited from two academic medical centers over 10 months was interviewed. Uncertainty was moderately high in patients with atrial fibrillation compared to other clinical populations. Among antecedents of uncertainty, higher education was significantly associated with less uncertainty (beta = -.21 to -.25). Except for tangible support, persons with greater social supports perceived less uncertainty (beta= -.25 to -.27), and individuals with greater perceived seriousness of illness reported greater uncertainty (beta= .30 to .33).

Uncertainty Intervention for Watchful Waiting in Prostate Cancer

Watchful waiting is a reasonable alternative to treatment for some older men with localized prostate cancer, but it inevitably brings uncertainty. This study tested the effectiveness of the watchful waiting intervention (WWI) in helping men cognitively reframe and manage the uncertainty of watchful waiting. Based on Mishel's Reconceptualized Uncertainty in Illness Theory (Image. 1990; 256-262), the WWI was tested with a convenience sample of 41 men. Experimental subjects received 5 weekly intervention calls from a nurse. Control subjects received usual care. Outcomes were new view of life, mood state, quality of life, and cognitive reframing. Repeated measures of analysis of variance were used to test the effectiveness of the WWI. The sample was 86% Caucasian and 14% African American, with an average age of 75.4 years. Intervention subjects were significantly more likely than controls to view their lives in a new light (P = .02) and experience a decrease in confusion (P = .04) following the intervention. Additionally, intervention subjects reported greater improvement in their quality of life than did controls (P = .01) and believed their quality of life in the future would be better than did controls (P = .01). This study's findings document the benefits of the WWI for patients living with uncertainty.