Prognostic uncertainty in multiple sclerosis: A concept analysis.

Abstract

AIM\nTo report an analysis of the concept of prognostic uncertainty in patients with multiple sclerosis (MS).\n\n\nBACKGROUND\nThe complexity and ambiguity involved in a diagnosis of MS lead to the occurrence of prognostic uncertainty among patients. A concept analysis is presented that analyses what prognostic uncertainty means to those experiencing the transition between relapsing-remitting multiple sclerosis and secondary progressive multiple sclerosis.\n\n\nDESIGN\nConcept analysis.\n\n\nDATA SOURCES\nPubMed, Ovid Medline, Cumulative Index for Nursing and Allied Health Literature databases were searched for literature published within the last 10\xa0years using combinations of the terms prognostic and diagnostic uncertainty, and multiple sclerosis along with archival referencing.\n\n\nMETHODS\nThe Walker and Avant method was used to analyse the concept of prognostic uncertainty in patients with MS.\n\n\nRESULTS\nThe defining attributes identified that provide additional context to prognostic uncertainty are illness uncertainty, intolerance of uncertainty and progressive dwindling. Related, contrary, model and borderline cases are presented to further discuss the application of the key attributes to the concept.\n\n\nCONCLUSION\nThere are limited data on prognostic uncertainty and multiple sclerosis; however, patients and physicians express uncertainty in understanding one s disease trajectory and determining when a patient with relapsing-remitting multiple sclerosis has entered the secondary progressive multiple sclerosis disease course leading to ineffective communication and frustration.\n\n\nRELEVANCE TO CLINICAL PRACTICE\nGenetics and genomics have the potential to provide a prognostic factor for addressing the concept of uncertainty as it relates to persons with multiple sclerosis. Moving beyond the concept analysis, a case is made for nurse involvement in genetic and genomic research to conduct trials, translate, and apply these findings to clinical practice and nursing curricula, addressing the uncertainty experienced by those afflicted with chronic illnesses, such as multiple sclerosis.