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CHAPTER 28 Merle H. Mishel 565

CASE STUDY her treatment plan is different from what her
primary physician told her to expect (event con-
Part 1: Original Theory gruence) and how she will manage her family life
Rosie, a 45-year-old mother of three, has been while undergoing treatment. Lily provides an
diagnosed with stage III breast cancer. A mass was audiotape of the treatment conference so that
detected in her left breast during her annual gyne- Rosie’s husband (structure provider–social sup-
cological appointment, and she has undergone an port) can hear what took place and can support
extensive diagnostic workup, including mammog- Rosie in asking questions and understanding the
raphy and sentinel node biopsy. She was referred information provided. Lily’s support for Rosie
by her primary physician to a comprehensive and her family continues throughout Rosie’s
breast cancer program at a regional medical center treatment course, and she periodically reassesses
that was 2 hours from her home. The multidisci- the sources of uncertainty and the strategies that
plinary team has recommended that Rosie un- Rosie and her family use to manage them.
dergo preoperative chemotherapy, followed by
partial mastectomy and reconstructive surgery. Part 2: Reconceptualized Theory
Rosie’s husband has accompanied her to most of Two years after her breast cancer diagnosis, Rosie
her medical encounters, but he was unable to at- returns to the center for a follow-up appointment.
tend the final conference, where the treatment Lily asks Rosie to reflect on her cancer experience.
recommendations were made. Rosie describes the time of diagnosis and treat-
Lily, the advanced practice nurse coordinating ment as chaotic and dominated by uncertainty,
Rosie’s care (structure provider-credible author- and she wonders how she and her family got
ity), directs her interventions toward addressing through it, but she tells Lily that gradually she
the many sources of uncertainty for Rosie and came to see the cancer experience as providing
her family, including lack of information about new meaning to her life and helping her set pri-
treatment options and outcomes (event familiar- orities. She left a job she was dissatisfied with and
ity), unfamiliarity with the treatment environ- now directs her energy toward her relationships
ment (event familiarity), expectations for chemo- with her teenage children. Rosie and her husband
therapy side effects and postoperative recovery recently enjoyed a long-postponed second honey-
(symptom pattern), impact of treatment on fam- moon trip to Hawaii. She tells Lily that she now
ily relationships, and prognosis. In particular, embraces each day as an opportunity to live life
Lily addresses Rosie’s many questions about why and enrich the lives of her children.

CRITICAL THINKING ACTIVITIES
1. You have been assigned to a new patient. You want During an exacerbation of her disease, she
to know about this person’s perceptions of the cur- focuses on her plans for going to law school.
rent situation, supportive relationships, and previous One of your colleagues suggests that she may
experiences with health and illness. What questions be in denial about the severity of her illness.
would you ask to assess the level of uncertainty? Use the reconceptualized Uncertainty in Illness
2. You are working with a young woman who has Theory to propose an alternative interpretation
been living with multiple sclerosis for 6 years. of her perspective.

POINTS FOR FURTHER STUDY
n Germino, B. B., Mishel, M. H. Crandell, J., Porter, younger African American and Caucasian breast
L. Blyler, D. Jenerette, C., et al. (2013). Outcomes cancer survivors. Oncology Nursing Forum, 40(1),
of an uncertainty management intervention in 82–92.