Hope, Uncertainty, and Control: A Theoretical Integration in the Context of Serious Illness

Background: Hope has been a topic of interest across many centuries and among diverse cultures, gaining particular relevance in crisis and change-seeking times. Research has shown that hope plays an important role in both the context of everyday life as well as in the context of illness. This paper presents an integrative theory of hope, which incorporates uncertainty and control as key drivers of the hope process and also includes appraisal and meaning. Discussion: The new hope theory states that hope emerges when a specific situation is appraised as uncertain and involves the discernment of the utility of primary and secondary control. For example, in the context of high uncertainty and low control, importance is given to the meaning-making and transcendence in maintaining hope. In the context of low uncertainty and high control, importance is given to the agency and self-efficacy components of hope. Conclusions: Although this integrative theory is based on current theory and evidence, it awaits empirical evidence for the integration of hope, uncertainty, and control in a process-oriented model of hope. The integrative theory has clinical utility, particularly for serious illness and palliative. care where uncertainty, hope and control transform with the trajectory of the illness.