Merle H. Mishel

Finding meaning: antecedents of uncertainty in illness.

In this study a portion of the uncertainty in illness model was tested. Antecedents to uncertainty tested were the stimuli frame variables of symptom pattern and event familiarity and the structure provider variables of education, social support, and credible authority. Data were collected on a convenience sample of 61 women with gynecological cancer at the time of major treatment effect. Findings supported the proposed model with an empirically generated revised model presenting the influence of antecedents on specific areas of uncertainty. Divergent paths for reducing uncertainty were found. Social support, credible authority, and event familiarity had the greatest influence on lowering the level of uncertainty. Event familiarity and credible authority were primarily effective in reducing the complexity surrounding treatment and the system of care. Social support functioned to decrease the level of ambiguity concerning the state of the illness. Findings generally support the proposed explanation for uncertainty arousal and have substantive significance in identifying the sources of stimuli leading to uncertainty arousal and modification.

Uncertainty in chronic illness.

In this chapter, the research on uncertainty in chronic illness is reviewed and critiqued. Two theoretical perspectives of uncertainty that can be applied across the range of chronic illness are presented. Research on the causes and consequences of uncertainty in chronic illness are considered and critiqued. The review addresses research on adults and on parents of chronically ill children. Conclusions include the areas requiring further investigation.

Helping patients with localized prostate carcinoma manage uncertainty and treatment side effects: nurse-delivered psychoeducational intervention over the telephone.

The objective of this study was to test the efficacy of an individualized uncertainty management intervention delivered by telephone to Caucasian and African‐American men with localized prostate carcinoma and directed at managing the uncertainties of their disease and treatment.

Uncertainty in Acute Illness

In this chapter, the research on uncertainty in acute illness is reviewed and critiqued. Both qualitative and quantitative studies are included. The review considers the cause and consequences of uncertainty from research on adults and from research on parents of acutely ill children.

Predictors of psychosocial adjustment in patients newly diagnosed with gynecological cancer

ABSTRACTThe influence of uncertainty, optimism, seriousness of the illness, and control over physical function upon psycho-social adjustment in 54 women with gynecologic cancer was studied during the time period between receiving a diagnosis and beginning treatment. Three of the four variables were

Triggers of uncertainty about recurrence and long-term treatment side effects in older African American and Caucasian breast cancer survivors.

PURPOSE/OBJECTIVES To examine the sources of uncertainty in older African American and Caucasian long-term breast cancer survivors by focusing on frequency of triggers of uncertainty about cancer recurrence and physical symptoms linked to long-term treatment side effects. DESIGN In the context of a larger randomized, controlled treatment-outcome study, data were gathered from 10 monthly follow-up telephone calls by nurses. SETTING Rural and urban regions of North Carolina. SAMPLE 244 older women (mean age = 64 years); 73 African American women and 171 Caucasian women who were five to nine years after breast cancer diagnosis. FINDINGS The most frequent triggers were hearing about someone elses cancer and new aches and pains. The most frequent symptoms were fatigue, joint stiffness, and pain. Although no ethnic differences occurred in the experience of symptoms, Caucasian women were more likely than African American women to report that their fears of recurrence were triggered by hearing about someone elses cancer, environmental triggers, and information or controversy about breast cancer discussed in the media. CONCLUSIONS Illness uncertainty persisted long after cancer diagnosis and treatment, with most women experiencing multiple triggers of uncertainty about recurrence and a range of symptoms and treatment side effects. IMPLICATIONS FOR NURSING Nurses can help cancer survivors to identify, monitor, and manage illness uncertainty and emotional distress.

Uncertainty in gynecological cancer: a test of the mediating functions of mastery and coping.

The purpose of this study was to test a portion of the uncertainty in illness model to determine whether mastery would be strengthened or weakened under conditions of uncertainty, and to test the ability of mastery and coping to function as mediators in the model. Mastery was proposed to mediate the relationship between uncertainty and the appraisal of danger and opportunity. Coping was proposed to mediate the relationships between danger or opportunity and emotional distress. Data were collected on a sample of 131 women receiving treatment for gynecological cancer. Findings support mastery as weakened under conditions of uncertainty and functioning as a situationally specific personality factor. Mastery was a significant mediator of the relationship between uncertainty and the appraisal of danger and opportunity; although the mediation effect for the relationship between uncertainty and danger was stronger. While two coping strategies were found to function as significant mediators between danger or opportunity and emotional distress, the mediation effect was very small.

Uncertainty intervention for watchful waiting in prostate cancer.

Watchful waiting is a reasonable alternative to treatment for some older men with localized prostate cancer, but it inevitably brings uncertainty. This study tested the effectiveness of the watchful waiting intervention (WWI) in helping men cognitively reframe and manage the uncertainty of watchful waiting. Based on Mishels Reconceptualized Uncertainty in Illness Theory (Image. 1990; 256–262), the WWI was tested with a convenience sample of 41 men. Experimental subjects received 5 weekly intervention calls from a nurse. Control subjects received usual care. Outcomes were new view of life, mood state, quality of life, and cognitive reframing. Repeated measures of analysis of variance were used to test the effectiveness of the WWI. The sample was 86% Caucasian and 14% African American, with an average age of 75.4 years. Intervention subjects were significantly more likely than controls to view their lives in a new light (P = .02) and experience a decrease in confusion (P = .04) following the intervention. Additionally, intervention subjects reported greater improvement in their quality of life than did controls (P = .01) and believed their quality of life in the future would be better than did controls (P = .01). This studys findings document the benefits of the WWI for patients living with uncertainty.

Uncertainty in illness theory: a replication of the mediating effects of mastery and coping.

The purpose of this investigation was to replicate a test of the mediating functions of mastery and coping and to determine whether the relationships found in the initial test of the model would hold with a sample more heterogenous than the original sample. One hundred women receiving treatment for gynecological cancer participated in the investigation. Of the 14 relationships in the model, only 5 replicated significant paths and had overlapping confidence intervals. Two moderators were proposed to explain the differences between the initial and replication tests of the model and to improve the specificity of the theory.

Family adjustment to heart transplantation: redesigning the dream

The processes family members of heart transplant recipients use to manage the unpredictability evoked by the need for and receipt of heart transplantation were explored. Twenty family members were theoretically sampled using the grounded theory approach. Three separate family support groups, each of 12 weeks duration, provided data for constant comparative analysis. Redesigning the dream was identified as the integrative theme in the substantive theory that described how family members gradually modify their beliefs about organ transplantation and develop attitudes and beliefs to meet the challenge of living with continual unpredictability. The theory consists of three concepts—immersion, passage, and negotiation—which parallel the stages of waiting for a donor, hospitalization, and recovery.