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Existential uncertainty in health care: Developing the concept

Dwan, C. (2021). Existential uncertainty in health care: Developing the concept. (Unpublished Doctoral thesis, City, University of London)


Rationale, aims and objectives According to an influential taxonomy of uncertainty in health care (Han, Klein & Arora, 2011), existential uncertainty is a key aspect of uncertainty for patients alongside more heavily researched aspects such as uncertainty around diagnosis, prognosis, treatment recommendations, etc. 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 research is to construct a theoretically-informed conceptualisation of existential uncertainty within the context of an established taxonomy.

The concept of existential uncertainty was analysed and further developed using a methodology known as the hybrid model of concept development (Schwartz-Barcott & Kim, 2000), which was pioneered by nursing scholars. The analysis involved three phases: an analysis of the concept of existential uncertainty in existing literature; a thematic analysis of semi-structured interviews carried out with six people who reported experiencing uncertainty in relation to their cancer diagnosis; and a synthesis of these two analyses. The synthesis yielded a list of defining attributes of existential uncertainty, a list of features that distinguish it from other concepts within the taxonomy, and a narrative conceptualisation.

Existential uncertainty is conceptualised as a bodily awareness at cognitive or precognitive levels that is focused on the undetermined but finite nature of one’s future, as well as on identity and meaning. This awareness is argued to be a consequence of living with the spectre of dying in a context characterised by questions of control and agency. The analysis suggests that existential uncertainty is concerned with: meaning rather than discoverable facts; the person rather than the disease; and the fundamental principles of existence rather than the practicalities of living. The thesis concludes with a discussion of the implications of this conceptualisation for the taxonomy on which the research was based; for psycho-oncology and cancer care more generally; and for counselling psychology as a discipline.

Publication Type: Thesis (Doctoral)
Subjects: B Philosophy. Psychology. Religion > BF Psychology
Departments: Doctoral Theses
Doctoral Theses > School of Arts and Social Sciences Doctoral Theses
School of Health & Psychological Sciences > Psychology
[thumbnail of REDACTED_DPsych portfolio for library - Conor Dwan_Redacted.pdf]
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