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The illness uncertainty concept: A review

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Abstract

Illness uncertainty is present for both acute and chronic illnesses and has been described in the literature as a cognitive stressor, a sense of loss of control, and a perceptual state of doubt that changes over time. Illness uncertainty is associated with poor adjustment, but often needs to be appraised as a threat to have its deleterious effect. In pain populations, illness uncertainty is related to heightened sensitivity to pain and reduced tolerance of painful stimuli. Illness uncertainty also has been related to maladaptive coping, higher psychological distress, and reduced quality of life. The illness uncertainty literature in relation to pain is somewhat limited but clearly suggests the potential negative impact on the perception of and adjustment to pain. Future research should examine specific predictors of illness uncertainty, how this construct changes over time, and what interventions may be effective in reducing illness uncertainty for individuals who experience pain conditions.

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References and Recommended Reading

  1. Mast ME: Adult uncertainty in illness: a critical review of research. Sch Inq Nurs Pract 1995, 9:3–24; discussion 25–29.

    PubMed  CAS  Google Scholar 

  2. Mishel MH: Uncertainty in chronic illness. Annu Rev Nurs Res 1999, 17:269–294.

    PubMed  CAS  Google Scholar 

  3. Mishel MH: Uncertainty in illness. Image J Nurs Sch 1988, 20:225–232.

    Article  PubMed  CAS  Google Scholar 

  4. Mishel MH: Reconceptualization of the uncertainty in illness theory. Image J Nurs Sch 1990, 22:256–262.

    Article  PubMed  CAS  Google Scholar 

  5. Penrod J: Refinement of the concept of uncertainty. J Adv Nurs 2001, 34:238–245.

    Article  PubMed  CAS  Google Scholar 

  6. Wiener CL, Dodd MJ: Coping amid uncertainty: an illness trajectory perspective. Sch Inq Nurs Pract 1993, 7:17–31; discussion 33–35.

    PubMed  CAS  Google Scholar 

  7. Mishel MH: The measurement of uncertainty in illness. Nurs Res 1981, 30:258–263.

    Article  PubMed  CAS  Google Scholar 

  8. Bailey JM, Nielsen BI: Uncertainty and appraisal of uncertainty in women with rheumatoid arthritis. Orthop Nurs 1993, 12:63–67.

    Article  PubMed  CAS  Google Scholar 

  9. Lazarus R, Folkman S: Stress, Appraisal, and Coping. New York: Springer; 1984.

    Google Scholar 

  10. Loeser JD, Melzack R: Pain: an overview. Lancet 1999, 353:1607–1609.

    Article  PubMed  CAS  Google Scholar 

  11. Mishel MH: Perceived uncertainty and stress in illness. Res Nurs Health 1984, 7:163–171.

    Article  PubMed  CAS  Google Scholar 

  12. Mishel MH: Uncertainty in Illness Scale Manual. Chapel Hill, NC: University of North Carolina School of Nursing; 1997.

    Google Scholar 

  13. Mishel MH: Parents’ perception of uncertainty concerning their hospitalized child. Nurs Res 1983, 32:324–330.

    Article  PubMed  CAS  Google Scholar 

  14. Ploghaus A, Narain C, Beckmann CF, et al.: Exacerbation of pain by anxiety is associated with activity in a hippocampal network. J Neurosci 2001, 21:9896–9903.

    PubMed  CAS  Google Scholar 

  15. Rhudy JL, Meagher MW: Fear and anxiety: divergent effects on human pain thresholds. Pain 2000, 84:65–75.

    Article  PubMed  CAS  Google Scholar 

  16. Sawamoto N, Honda M, Okada T, et al.: Expectation of pain enhances responses to nonpainful somatosensory stimulation in the anterior cingulate cortex and parietal operculum/posterior insula: an event-related functional magnetic resonance imaging study. J Neurosci 2000, 20:7438–7445.

    PubMed  CAS  Google Scholar 

  17. Brown CA, Seymour B, Boyle Y, et al.: Modulation of pain ratings by expectation and uncertainty: behavioral characteristics and anticipatory neural correlates. Pain 2008, 135:240–250.

    Article  PubMed  Google Scholar 

  18. Dickerson SS, Kemeny ME: Acute stressors and cortisol responses: a theoretical integration and synthesis of laboratory research. Psychol Bull 2004, 130:355–391.

    Article  PubMed  Google Scholar 

  19. Lawrence RC, Helmick CG, Arnett FC, et al.: Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum 1998, 41:778–799.

    Article  PubMed  CAS  Google Scholar 

  20. Wolfe F, Hawley DJ: Psychosocial factors and the fibromyalgia syndrome. Z Rheumatol 1998, 57(Suppl 2):88–91.

    Article  PubMed  Google Scholar 

  21. Wolfe F, Ross K, Anderson J, et al.: The prevalence and characteristics of fibromyalgia in the general population. Arthritis Rheum 1995, 38:19–28.

    Article  PubMed  CAS  Google Scholar 

  22. Reich JW, Johnson LM, Zautra AJ, Davis MC: Uncertainty of illness relationships with mental health and coping processes in fibromyalgia patients. J Behav Med 2006, 29:307–316.

    Article  PubMed  Google Scholar 

  23. Johnson LM, Zautra AJ, Davis MC: The role of illness uncertainty on coping with fibromyalgia symptoms. Health Psychol 2006, 25:696–703.

    Article  PubMed  Google Scholar 

  24. Akkasilpa S, Minor M, Goldman D, et al.: Association of coping responses with fibromyalgia tender points in patients with systemic lupus erythematosus. J Rheumatol 2000, 27:671–674.

    PubMed  CAS  Google Scholar 

  25. Reich JW, Olmsted ME, van Puymbroeck CM: Illness uncertainty, partner caregiver burden and support, and relationship satisfaction in fibromyalgia and osteoarthritis patients. Arthritis Rheum 2006, 55:86–93.

    Article  PubMed  Google Scholar 

  26. Braden CJ: A test of the Self-Help Model: learned response to chronic illness experience. Nurs Res 1990, 39:42–47.

    Article  PubMed  CAS  Google Scholar 

  27. Chaney JM, Mullins LL, Uretsky DL, et al.: Attributional style and depression in rheumatoid arthritis: the moderating role of perceived illness control. Rehabil Psychol 1996, 41:205–223.

    Article  Google Scholar 

  28. Hoff AL, Mullins LL, Chaney JM, et al.: Illness uncertainty, perceived control, and psychological distress among adolescents with type 1 diabetes. Res Theory Nurs Pract 2002, 16:223–236.

    PubMed  Google Scholar 

  29. Affleck G, Tennen H, Pfeiffer C, Fifield J: Appraisals of control and predictability in adapting to a chronic disease. J Pers Soc Psychol 1987, 53:273–279.

    Article  PubMed  CAS  Google Scholar 

  30. Bar-Tol Y: Uncertainty and the perception of sufficiency of social support, control, and information. Psychol Rec 1994, 44:13–25.

    Google Scholar 

  31. Webster DC, Brennan T: Use and effectiveness of psychological self-care strategies for interstitial cystitis. Health Care Women Int 1995, 16:463–475.

    Article  PubMed  CAS  Google Scholar 

  32. Lemaire GS: More than just menstrual cramps: symptoms and uncertainty among women with endometriosis. J Obstet Gynecol Neonatal Nurs 2004, 33:71–79.

    Article  PubMed  Google Scholar 

  33. LeFort S: A test of Braden’s self-help model in adults with chronic pain. J Nurs Scholarsh 2000, 32:153–160.

    Article  PubMed  CAS  Google Scholar 

  34. Landis BJ: Uncertainty, spiritual well-being, and psychosocial adjustment to chronic illness. Issues Ment Health Nurs 1996, 17:217–231.

    Article  PubMed  CAS  Google Scholar 

  35. Christman NJ: Uncertainty and adjustment during radiotherapy. Nurs Res 1990, 39:17–20, 47.

    Article  PubMed  CAS  Google Scholar 

  36. Mishel MH, Hostetter T, King B, Graham V: Predictors of psychosocial adjustment in patients with newly diagnosed gynecological cancer. Cancer Nurs 1984, 7:291–299.

    Article  PubMed  CAS  Google Scholar 

  37. Mishel MH, Sorenson DS: Uncertainty in gynecological cancer: a test of the mediating functions of mastery and coping. Nurs Res 1991, 40:167–171.

    PubMed  CAS  Google Scholar 

  38. Mullins LL, Chaney JM, Hartman VL, et al.: Cognitive and affective features of postpolio syndrome: illness uncertainty, attributional style, and adaptation. Int J Rehabil Health 1995, 1:211–222.

    Article  Google Scholar 

  39. Sanders-Dewey NEJ, Mullins LL, Chaney JM: Coping style, perceived uncertainty in illness, and distress in individuals with Parkinson’s disease and their caregivers. Rehabil Psychol 2001, 46:363–381.

    Article  Google Scholar 

  40. Mullins LL, Cote MP, Fuemmeler BF, et al.: Illness intrusiveness, uncertainty, and distress in individuals with multiple sclerosis. Rehabil Psychol 2001, 46:139–153.

    Article  Google Scholar 

  41. Wineman NM, Schwetz KM, Goodkin DE, Rudick RA: Relationships among illness uncertainty, stress, coping, and emotional well-being at entry into a clinical drug trial. Appl Nurs Res 1996, 9:53–60.

    Article  PubMed  CAS  Google Scholar 

  42. McCormick KM: A concept analysis of uncertainty in illness. J Nurs Scholarsh 2002, 34:127–131.

    Article  PubMed  Google Scholar 

  43. Bailey DE, Mishel MH, Belyea M, et al.: Uncertainty intervention for watchful waiting in prostate cancer. Cancer Nurs 2004, 27:339–346.

    Article  PubMed  Google Scholar 

  44. Gil KM, Mishel MH, Belyea M, et al.: Benefits of the uncertainty management intervention for African American and white older breast cancer survivors: 20-month outcomes. Int J Behav Med 2006, 13:286–294.

    Article  PubMed  Google Scholar 

  45. McCain NL, Cella DF: Correlates of stress in HIV disease. West J Nurs Res 1995, 17:141–155.

    Article  PubMed  CAS  Google Scholar 

  46. Benjaminsson O, Biguet G, Arvidsson I, Nilsson-Wikmar L: Recurrent low back pain: relapse from a patient’s perspective. J Rehabil Med 2007, 39:640–645.

    Article  PubMed  Google Scholar 

  47. Corbett M, Foster NE, Ong BN: Living with low back pain: stories of hope and despair. Soc Sci Med 2007, 65:1584–1594.

    Article  PubMed  Google Scholar 

  48. Jerlock M, Gaston-Johansson F, Danielson E: Living with unexplained chest pain. J Clin Nurs 2005, 14:956–964.

    Article  PubMed  Google Scholar 

  49. Lillrank A: Back pain and the resolution of diagnostic uncertainty in illness narratives. Soc Sci Med 2003, 57:1045–1054.

    Article  PubMed  Google Scholar 

  50. Lutze U, Archenholtz B: The impact of arthritis on daily life with the patient perspective in focus. Scand J Caring Sci 2007, 21:64–70.

    Article  PubMed  Google Scholar 

  51. Yoshida K: Uncertainty in the lives of people with spinal cord injury and rheumatoid arthritis. Can J Rehabil 1997, 10:5–14.

    Google Scholar 

  52. Brown KW, Ryan RM: The benefits of being present: mindfulness and its role in psychological well-being. J Pers Soc Psychol 2003, 84:822–848.

    Article  PubMed  Google Scholar 

  53. Carleton RN, Sharpe D, Asmundson GJ: Anxiety sensitivity and intolerance of uncertainty: requisites of the fundamental fears? Behav Res Ther 2007, 45:2307–2316.

    Article  PubMed  Google Scholar 

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Correspondence to Lisa Johnson Wright.

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Wright, L.J., Afari, N. & Zautra, A. The illness uncertainty concept: A review. Current Science Inc 13, 133–138 (2009). https://doi.org/10.1007/s11916-009-0023-z

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