Existential uncertainty in health care: A concept analysis

Rationale, aims and objectives: According to an influential taxonomy of varieties of uncertainty in health care, existential uncertainty is a key aspect of uncertainty for patients. Although the term "existential uncertainty" appears across a number of disciplines in the research literature, its use is diffuse and inconsistent. To date there has not been a systematic attempt to define it. The aim of this study is to generate a theoretically-informed conceptualisation of existential uncertainty within the context of an established taxonomy. Method: Existential uncertainty was subjected to a concept analysis, which drew on existing uses of the term across multiple disciplines as well as insights from uncertainty theory more broadly and from the existential therapy literature to generate a tentative definition of the concept. Antecedents, consequences, and empirical referents of existential uncertainty were also identified. A model case was described as well as a borderline case and a related case in order to illustrate and delineate the concept. Results: Existential uncertainty is conceptualised as an awareness of the undetermined but finite nature of one's own being-in-the-world, concerned primarily with identity, meaning, and choice. This awareness is fundamental and ineradicable, and manifests at different levels of consciousness. Conclusion: Humans rely on identity, worldview, and a sense of meaning in life as ways of managing the ineradicable uncertainty of our being-in-the-world, and these can be challenged by a serious diagnosis. It is important that medical professionals acknowledge issues around existential uncertainty as well as issues around scientific uncertainty, and recognise when patients might be struggling with these. Further research is required to identify ways of measuring existential uncertainty and to develop appropriate interventions, but it is hoped that this conceptualisation provides a useful first step towards that goal.