Kathleen L. Neville (2003) — Uncertainty in Illness: An Integrative Review

Vocabulary terms and definitions covering forms of uncertainty, Mishel's Theory of Uncertainty in Illness, preparatory information, and relational inquiry factors from Neville's integrative review.

Uncertainty (in illness)

The inability to interpret illness-related events, assign definite meaning, or accurately predict outcomes.

Temporal uncertainty

A form of uncertainty where an event or harm is anticipated, but its specific timing is unknown.

Event uncertainty

A form of uncertainty where the time is known, but whether the event will actually occur remains uncertain.

Clinical/professional uncertainty

Genuine difficulty experienced by healthcare professionals in making a diagnosis, prognosis, or treatment decision.

Functional uncertainty

Uncertainty maintained by a professional even after clinical knowledge is available, historically used as a descriptive concept to manage patients and families.

Stimulus/stimuli frame

An antecedent in Mishel's theory composed of symptom pattern, event familiarity, and event congruence that helps an individual organize meaning.

Cognitive capacity

An individual's information-processing ability, which may be temporarily compromised by anxiety, fatigue, drugs, illness, and treatments.

Structure providers

Resources—specifically credible professional authority, education, and social support—that assist an individual in interpreting illness events.

Appraisal of uncertainty as danger

A cognitive evaluation that prompts an individual to engage in mobilizing or affect-control coping strategies to reduce uncertainty.

Appraisal of uncertainty as opportunity

A cognitive evaluation that prompts an individual to engage in buffering coping strategies to preserve hope through not knowing.

Reconceptualization of uncertainty

Mishel's later theory formulation for chronic illness describing the construction of a new orientation to life when certainty, mastery, and control are no longer reliable assumptions.

Sensory information

Preparatory information provided before procedures that explains what an experience or intervention may feel like.

Cognitive information

Preparatory information provided before procedures that explains what will happen during an intervention and why.

Intrapersonal factors (Relational inquiry)

Individual-level elements to explore in relational inquiry, including meaning, danger/opportunity appraisal, information preferences, fatigue, anxiety, and the need for control.

Interpersonal factors (Relational inquiry)

Relational dynamics between patients and families, including differing understandings, shared decision making, family cohesion, desired support, and silence or overprotection.

Contextual factors (Relational inquiry)

System and environmental factors—such as unfamiliar hospitals, language barriers, specialists, procedures, regional travel, and rotating staff—that can intensify uncertainty.