THE MARITAL CONTEXT OF END-STAGE RENAL-DISEASE - ILLNESS INTRUSIVENESS AND PERCEIVED CHANGES IN FAMILY ENVIRONMENT

End-stage renal disease (ESRD) is associated with illness-induced disr uptions (i.e. illness intrusiveness) that challenge patients and their families to accommodate and adapt. We advance previous research in ES RD by examining the extent to which illness intrusiveness extends to m arital, non-marital, and family life among patients and their spouses. We also investigate whether gender and mode of renal replacement ther apy moderate these effects. A sample of 19 ESRD patients and their spo uses completed the Illness Intrusiveness Ratings Scale and the Family Environment Scale (FES) (completed with reference to two time frames, currently and before ESRD) in structured individual interviews. As hyp othesized, ESRD patients reported significantly higher illness intrusi veness than their spouses, but this discrepancy was greater in relatio n to aspects of non-marital as compared to marital life. Significant m oderating effects were observed for gender on the FES Relationship sub scale and mode of renal replacement on the FES Personal Growth subscal e. Spouses reported significantly more family emphasis on norms and th e regulation of family members' behavior (FES System Maintenance) than patients. A pattern of significant correlations linked patient rating s of illness intrusiveness with both premorbid and current family envi ronment. The pattern of findings is consistent with previous clinical reports that women and spouses are more likely than their male and pat ient counterparts to shoulder much of the burden of adapting family en vironment to accommodate life with ESRD and renal replacement therapy.