Mishel's framework is valuable in the sense that it outlines the causes and mechanisms of uncertainty and identifies how it can negatively affect the patient. In addition, Mishel's framework promotes management of the negativity of uncertainty.
Uncertainty can be difficult to manage because of its dual aspects, however. As Brashers (2001, p. 291) points out, "In some instances, people may want to reduce uncertainty because they find it threatening. At other times, uncertainty allows people to maintain hope and optimism." Although Mishel recognized that uncertainty can be not just negative but positive, her framework focuses primarily on the negative side of uncertainty, ignoring the fact that in some cases, a patient's only positive outlook lies in uncertainty (McCormick, 2002, p. 128). A patient uncertain of whether he has cancer can be highly stressed by that uncertainty. Likewise, if he knows he has cancer and is uncertain of the outcome, he can be stressed. Even if his cancer is in remission, uncertainty over whether it may recur or not can be stressful. On the other hand, a patient that has received a grim prognosis may find that the only hope he has lies in uncertainty-the uncertain hope that he may miraculously recover; for this patient, uncertainty is both desirable and potentially therapeutic. Thus, although Mishel's theory addresses an important aspect of