Family process, chronic illness, and death. On the weakness of strong bonds.

Newer techniques for directly measuring social interaction in families permit more informative studies of the family's role in the course of chronic illness. We used laboratory techniques for measuring problem-solving strategies in family groups, supplemented by measures of the family's intelligence and accomplishments as well as its intactness, the latter indicated by measures of duration of marriage and the survival of grandparents. We studied 23 families, each containing an adult patient with end-stage renal disease who was being treated by center-based hemodialysis. In sharp contrast to expectations based on previous data, high scores on the problem-solving variables, as well as the measures of accomplishment and intactness, predicted early death rather than survival. Equally surprising was the finding that noncompliance accounted for most of the association between the family variables and survival.