Deconstructing conceptualizations of 'adjustment' to chronic illness: a proposed integrative framework.

This article reviews the literature on 'adjustment' to chronic illness in general, and end-stage renal failure (ESRF) in particular, and discusses some of the inherent problems. A major limitation of published studies has been their arbitrary, fragmented and inconsistent conceptualization of 'adjustment'. The construct has typically been viewed in terms of a return to 'normal' social roles (e.g., work), an absence of psychiatric 'caseness' (e.g., on depression) or 'compliance/ adherence' with treatment. Few, if any, studies have considered the conceptualizations of patients, partners and/or professional caregivers. The present study investigates conceptualizations of 'adjustment' amongst end-stage renal failure (dialysis-dependent) patients, their partners and home dialysis nurses. Semi-structured interviews were conducted with 10 CAPD (continuous ambulatory peritoneal dialysis) patients, 5 partners/relatives and 3 home dialysis sisters. The findings are outlined in terms of the categories identified in the interviews, focusing on 'adopting a new approach to being and living'. The relation between emerging categories and active vs. resigned acceptance is also discussed. In conclusion, the themes associated with 'active' acceptance are highlighted and directions for further research are outlined.