Existential uncertainty in health care: A concept analysis

Abstract

Rationale, aims and objectives: According to an influential taxonomy of varieties of uncertainty in health care, existential uncertainty is a key aspect of uncertainty for patients.Although the term "existential uncertainty" appears across a number of disciplines in the research literature, its use is diffuse and inconsistent. To date there has not been a systematic attempt to define it. The aim of this study is to generate a theoretically-informed conceptualisation of existential uncertainty within the context of an established taxonomy.Method: Existential uncertainty was subjected to a concept analysis, which drew on existing uses of the term across multiple disciplines as well as insights from uncertainty theory more broadly and from the existential therapy literature to generate a tentative definition of the concept. Antecedents, consequences, and empirical referents of existential uncertainty were also identified. A model case was described as well as a borderline case and a related case in order to illustrate and delineate the concept.Results: Existential uncertainty is conceptualised as an awareness of the undetermined but finite nature of one's own being-in-the-world, concerned primarily with identity, meaning, and choice. This awareness is fundamental and ineradicable, and manifests at different levels of consciousness. Conclusion:Humans rely on identity, worldview, and a sense of meaning in life as ways of managing the ineradicable uncertainty of our being-in-the-world, and these can be challenged by a serious diagnosis. It is important that medical professionals acknowledge issues around existential uncertainty as well as issues around scientific uncertainty, and recognise when patients might be struggling with these. Further research is required to identify ways of measuring existential uncertainty and to develop appropriate interventions, but it is hoped that this conceptualisation provides a useful first step towards that goal.

Existential uncertainty in the patient cancer experience: Delimiting the concept

“…Secondly, this research is conceptual rather than phenomenological in nature. It is therefore concerned with the meaning structure of uncertainty, which is assumed to be relatively stable, enduring, and consistent across people (Dwan and Willig, 2021), not with the range of experiences that this structure might permitthe experiences of uncertainty among people living with cancer are expected to vary widely, and a phenomenological exploration of existential uncertainty would reasonably require a much larger sample size with more attention to sociodemographic variables, source of recruitment, and considerations of cancer type and stage in order to generate valid conclusions about the experience of existential uncertainty.…”

“…Although the term "existential uncertainty" has long featured in the health literature (e.g., Adamson, 1997), including in the context of cancer (e.g., Karlsson et al, 2014), we were unable to find a systematic conceptualization of existential uncertainty prior to the recent publication of our concept analysis (Dwan and Willig, 2021). This analysis drew on existing research literature in the fields of health, uncertainty, and existential therapy to develop a thoroughgoing and theoretically informed definition of the concept.…”

Humans, machines and decisions: Clinical reasoning in the age of artificial intelligence, evidence‐based medicine and Covid‐19

“…The series of papers that follows [10][11][12][13][14][15][16] adopts a pertinent shift in focus, to bring in the role of the arts and virtue in the development of human reasoning. Papers highlight new prospects for, and challenges to, the education of health professionals, regarding the cultivation of virtue, the role of culture, humility, existential uncertainty and 'hospitality'.…”

“…Papers highlight new prospects for, and challenges to, the education of health professionals, regarding the cultivation of virtue, the role of culture, humility, existential uncertainty and 'hospitality'. [10][11][12][13][14] Authors propose ways that practitioners can use their distinctively human skills and capacities to support patients navigating the disorienting territory of acute illness, 14 to provide genuinely person-centred responses to patients whose sense of meaning and identity may be undermined by serious threats to their health, 13 and more broadly to design a curriculum to enable medical learners to develop a fuller understanding of what it means 'to be human, live well, experience loss, encounter disease, and engage in a therapeutic relationship'. 11 The contributors suggest ways to 'broaden understandings of culture and associated workings of power to accommodate the effects of biomedicine's technologising turn', 12 and the section concludes with two rather novel 'non-evidence based lyric essays' 15,16 which chronicle the history of EBM.…”

Turkish adaptation of the Mishel uncertainty in illness scale‐community form

“…As in all other religions, beliefs in the Turkish Muslim societies affect life and health behavior in many respects, including the way diseases are managed and the level of uncertainty 14,15 . Religions, beliefs and cultural characteristics of societies have an impact on health and disease perceptions 16,17 . For example, the perception that events are determined by a divine power and the results will not change has an effect on cancer patients' and their families' ability to make sense of and cope with the disease 18…”