Dyadic Model of Adaptation to Life-Limiting Illness

Sangeeta Ahluwalia, Neha K. Reddy*, Rebecca Johnson, Linda Emanuel, Sara J. Knight

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Context: We previously developed the reintegration model to describe the adjustment process for individuals at the end of life. However, caregivers and loved ones also require significant support and must work to reimagine their relationship with one another. Objectives: We sought to develop a dyadic version of the reintegration model that delineates key parts of the adjustment process that occur between the patient and another significant person rather than as two separate individuals. Methods: We refined an initial conceptual model of this dyadic process with findings from a narrative literature review on spousal dyadic mutuality. We assessed emergent themes regarding dyadic adjustment from the literature for their fit with our original reintegration model and through consensus discussion, applied the findings to a final proposed conceptual model of dyadic reintegration at the end of life. Results: Examples of dyadic adjustment in the literature relate to the comprehension, creative adaptation, and reintegration processes described in the original reintegration model. Evidence also supported three substantive additions in the new dyadic model: (1) shared understanding that the harmony of the dyad is interrupted; (2) consideration of the "we"(the dyad) and the "I"(the individual) in mutual reflection to create a shared narrative; and (3) emphasis on relationship as a factor impacting adjustment processes. Conclusions: Available evidence supports interdependent relationships between members of dyads for the three adaptation processes of comprehension, creative adaptation, and reintegration in the model. This dyadic reintegration model can be useful in clinical practice to support dyads facing life-limiting illness.

Original languageEnglish (US)
Pages (from-to)1177-1183
Number of pages7
JournalJournal of palliative medicine
Issue number9
StatePublished - Sep 1 2020


  • adjustment
  • cancer
  • dyad
  • mutuality
  • oncology
  • palliative care

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • General Nursing


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