Patient, family, and staff responses to end-stage renal disease.

The course of a chronic illness is composed of discrete developmental phases, which influence the relationship of the patient to the care-giving system, and the tasks required of patients, families, and medical staff. Family characteristics may influence medical outcome. Compliance may be a critical factor in mediating the biological response to social phenomena. The relationship of the patient to his or her family and the health-care system may change dramatically through the developmental phases of the chronic disease. The case of a patient with end-stage renal disease (ESRD) illustrating these concepts is presented.