The Many Meanings of Uncertainty in Illness: Toward a Systematic Accounting

Abstract

Uncertainty is widely believed to be a central feature in illness experiences. Moreover, communication is thought to be essential to the construction, management, and resolution of uncertainty. Not surprisingly, however, there are substantial variations in conceptions and analyses of this focal construct and its relation to communication. In this article, we first argue that understandings of the role of communication in health and illness can be improved substantially--thereby enhancing both theory development and practical applications of health communication theory--by recognizing and reconciling sources of variation in conceptions of uncertainty and by synthesizing various specific conceptions. We then review individual-psychological models. linguistic and discourse analyses, and sociocultural and historical perspectives on uncertainty in illness Following the review, we present a framework that synthesizes many conceptions of uncertainty We close with a discussion of 5 challenges and opportunities for research and application.

Varieties of Uncertainty in Health Care: A Conceptual Taxonomy

“…2 The strength of this taxonomy is its greater detail and comprehensiveness compared to Mishel’s; however, it also has limitations. First, its conceptual categories are not clearly distinct, and some may be logically combined or subsumed within others; for example, “structure of information” can be subsumed within “qualities” of information.…”

“…These limitations are significant in that empirical evidence suggests that different types, sources, and manifestations of uncertainty may elicit divergent responses from people, and may thus warrant different actions on the part of health professionals. 2, 21, 24 To be useful, to researchers and clinicians, a conceptual taxonomy of uncertainty needs to differentiate between the many types, sources, and manifestations of uncertainty that lead to distinct effects.…”

“…At the most fundamental level, it is uncertainty of one form or another that fuels medical research, prompts patients to seek care, and stimulates medical intervention. 2, 3 The inability to abolish uncertainty, furthermore, promotes the perpetuation of these activities and creates difficult challenges for clinicians and patients.…”

“…Although groundbreaking work has been conducted by researchers from various disciplines including sociology, 3, 4, 9–11 bioethics, 12 health services research, 13–17 communication, 2 and nursing, 18, 19 the body of knowledge on the uncertainties faced by clinicians and patients is fragmented and incomplete, and important insights have not been translated to clinical practice. Consequently, we know little about the optimal means and outcomes of communicating uncertainty to patients and the public, 20 and even less about how to help clinicians, and patients cope with uncertainty.…”

“…21 Uncertainty has many conceptual meanings that are not often distinguished or explicitly considered. 2, 22, 23 Furthermore, uncertainty is not a monolithic phenomenon. There are multiple varieties of uncertainty, which may have distinct psychological effects and thus warrant different courses of action.…”