Family structure and patient survival in an African-American end-stage renal disease population: a preliminary investigation.

Few studies have examined the influence of the family on the course of chronic illness in African-Americans. We explore the relationship between family structure, defined as marital status and household composition, and patient survival. Patient gender was examined as a possible moderator in this relationship. Using data from a survey of 476 African-American end-stage renal disease (ESRD) patients, a significant association between household composition and patient survival was found. Results from Cox proportional hazards model, controlling for patient age, indicated that patients who live in 'complex' households (i.e. those with a partner and/or others) are at greater risk for shortened survival as compared to those who live alone or with a spouse/partner (p < 0.05). When we examined whether patient gender moderates this relationship, female patients who live in these households were found to be at 2 times greater risk for shortened survival (p < 0.01) than female patients who live alone or with their spouse/ partner only. Family structure was not significantly associated with survival in male patients. Discussion and implications of findings are addressed.

Staff security and work pressure: contrasting patterns of stability and change across five dialysis units.

Differences among clinical care units in social dynamics and social organization are associated with differences in the clinical course of patients with a range of chronic illness. These differences are also associated with well-being of staff members. Recent attention has focused on understanding these differences among units with an eye towards correcting deficiencies and enhancing strengths of clinical care units. The current study sought to delineate the effect of social and organizational dynamics unique to each unit on staff perceptions of the security of their relationships with other staff and their perceived work pressure. The unit as a major source of differences among staff subjects was compared with the impact of ethnic identity, of work in the morning shift vs other shifts, and of professional role. Results confirmed that unit membership was, by far, the most important correlate of staff perceptions of the unit, particularly those concerning security of relationships with others and perceived work pressure. Moreover, the results suggested that unit differences in perceived security were due to differences among units in long standing turmoil within the unit or long standing problematic ties between the unit and the larger institution which controls it. However, perceived work pressure seems more transient and may reflect the challenge of shorter-term fluctuations in the demands of patient care.

Engagement of African American families in research on chronic illness: a multisystem recruitment approach.

Our multisystem approach addressed the recruitment of African American families with a chronically, physically ill member. The approach focused on the social transactions between the family, the healthcare team, and the research staff, and the influence of these transactions on family recruitment. This multisystem approach included three core strategies: defining the membership of families in a culturally appropriate fashion and engaging those members; engaging the healthcare team; and building and maintaining the skills and morale of the research staff. A description of a longitudinal family health study and potential sources of recruitment biases is provided. Descriptive and bivariate analyses examined the effectiveness of the recruitment approach. A focus groups explored the reciprocal process of family protectiveness that both facilitated and hindered family recruitment and the research staff's alliance with families and the dialysis staff. Discussion focuses on the family health study's recruitment rate, sampling biases, and methods for improving the effectiveness of the multisystem recruitment approach.