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The purpose of this article is to report an integrative review of uncertainty in the illness experience, describe the uncertainty in illness theory, and to discuss the importance of assessing the appraisal of uncertainty experienced in illness with individuals and families faced with illness.
Uncertainty is a major component of the illness experience and can dramatically affect psychosocial adaptation and outcomes of disease states (McCormick, 2002). Uncertainty in illness is defined as the inability to determine the meaning of illness-related events, assign definite values to objects and events, and/or accurately predict outcomes (Mishel & Braden, 1988). Although much of the literature has addressed uncertainty in illness as a negative or aversive event, uncertainty reflects a neutral cognitive state and is neither a desired nor dreaded state until the implications of the uncertainty are determined (Mishel, 1990).
Individuals appraise the situation and determine the value placed upon the uncertainty; in short, whether uncertainty is viewed as a positive or negative event or as an opportunity or a danger. For example, fear of the unknown, confusion, lack of information, and ambiguity are major psychological stressors for many individuals and families faced with illness and hospitalization and may represent a danger to their health state. However, in other circumstances, such as when a downward course or negative trajectory is suspected or soon to be confirmed, maintaining uncertainty through the process of illusion is a preferred state and is viewed as a positive event. In other words, not knowing is better than knowing.
This article explores the perceptual variable of uncertainty in illness and provides a review of the literature of the experience of uncertainty in illness with an emphasis on orthopedic health conditions.
Uncertainty has been defined in the broad context of risk, choice, probability, and decision making. Parsons (1980) states that "exposure to uncertainty is perhaps the most negative aspect of human life and action as distinguished from lower forms of living systems" (p. 145). Uncertainty exists whenever individuals are unable to form a cognitive framework for understanding their situation and thus believe they are unable to predict the outcomes of their behaviors (Weitz, 1989). Uncertainty has also been described in the context of vagueness, ambiguity, lack of information, unpredictability, inconsistency, unfamiliarity, and temporality. Temporal uncertainty...