To optimize the success of educational interventions for adults with end-stage renal disease, we developed a psychosocial framework of illness adjustment. Currently, no stage-specific guidelines are available for understanding the psychosocial concerns of patients with end-stage renal disease nor are there specific models of coping with the disease. The content and implementation of educational programs must correspond to a patient's stage of adjustment to the illness. Psychological or psychiatric concerns may also affect participation in and response to educational interventions. Recommendations for structuring and implementing educational interventions about renal replacement that are specific to the unique psychosocial tasks associated with adjusting to each stage of end-stage renal disease are presented. Increased information about this disease and the treatment options available can be instrumental in improving patients' quality of life.