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CHAPTER 30 Carolyn L. Wiener; Marylin J. Dodd 601

addressing uncertainty (McCormick, 2002; Mishel, advanced the concept of uncertainty and identified
1997; Parry, 2003). Mishel (1997) has praised the different types of uncertainty. The experience of living
broad theoretical focus maintained through the with uncertainty was dynamic in nature with changes
qualitative approach to theory derivation. Much of in the types and modes of uncertainty, and various
the work in coping with illness is constrained by the types of uncertainty were guided by the primary
application of Lazarus and Folkman’s framework of tenets of confidence and a sense of control.
problem-based or emotion-based coping; however, These insights demonstrate an evolving body of
in this study, inductive reasoning produced data- research related to uncertainty, control, and the ill-
based theory that identifies a broad range of strate- ness trajectory. Rather than assume that uncertainty
gies related to tolerating and abating uncertainty is a negative aspect of life, researchers must remain
(Lazarus & Folkman, 1984; Mishel, 1997). The varia- open to positive transformational outcomes of living
tion and range of abatement strategies identified in through uncertainty. Wiener and Dodd’s original rec-
this theory are a unique and significant contribution ommendation remains salient, to expand the scope of
to the body of research in coping with the uncer- the illness trajectory framework (Wiener & Dodd,
tainty of illness. 1993). The illness trajectory theoretical framework is
especially useful for understanding the variations in
uncertainty and control and for gaining a fuller per-
Further Development spective of the human experience with cancer and
In an earlier response article to the original publica- other conditions where the significance of uncer-
tion, Oberst (1993) took issue with the delimitation of tainty and control may vary.
the concept of uncertainty to loss of control. This criti-
cism was echoed by McCormick (2002), who theoreti- Critique
cally positioned loss of control in the uncertainty cycle
rather than as a manifestation of a state of uncertainty. Clarity
In their work on end-of-life caregiving, Penrod and One concern in the clarity in Wiener and Dodd’s
colleagues (2012, 2011) posit that minimizing uncer- Theory of Illness Trajectory is the delimitation of the
tainty by increasing confidence and control is desirable concept of uncertainty to a loss of control. This lim-
for patients and their family caregivers transitioning ited conceptual perspective of uncertainty is clearly
through the end-of-life trajectory. Further research set forth in the work; therefore, this issue does not
into the concept of control is warranted to untangle the create a significant or fatal flaw in the work. The the-
conceptual boundaries and linkages between control ory is delineated clearly and well supported by previ-
and uncertainty throughout the illness trajectory. ous work in illness trajectories. Propositional clarity is
Other researchers have criticized the implicit as- achieved in the logical presentation of relationships
sertion that uncertainty (or loss of control) is always a and linkages between concepts. The conceptual deri-
negative event that requires some form of abatement vation of managing illness as work is well developed
(Oberst, 1993; Parry, 2003). Oberst (1993) suggested and provides unique insight into the meaning of liv-
the need for further investigation to differentiate ing through chemotherapy during cancer treatment.
work related to tolerating uncertainty from abate- The application of the trajectory model is used consis-
ment work in order to reveal how effective strategies tently to demonstrate the dynamic fluctuations in
in each type of work affect the sense of uncertainty coping, not in clearly demarcated stages or phases,
throughout the trajectory. Parry (2003) studied survi- but in situation-specific contexts of the work of man-
vors of childhood cancer and revealed that although aging illness.
uncertain states may be a problematic stressor for
some, a more universal theme of embracing uncer- Simplicity
tainty toward transformational growth was evident in This complex theory is interpreted in a highly accessible
these survivors. manner. The Theory of Illness Trajectory adopts a so-
Penrod (2007) helped to clarify the concept of un- ciological framework that is applied to a phenomenon
certainty with a phenomenological investigation that of concern to nursing: chemotherapeutic treatment of