title: Parents' experiences of living with, and caring for children, adolescents and young adults with Mucopolysaccharidosis (MPS).
abstract: Many rare diseases of childhood are life-threatening and chronically debilitating, so living with a rare disease is an on-going challenge for patients and their families. MPS is one of a range of rare inherited metabolic disorders (IMDs) that come under category 3 of life-limiting conditions, where there is no curative treatment available at present. Although the study of rare diseases is increasingly novel, and of clinical importance to the population, the lack of empirical data in the field to support policy and strategy development is a compelling argument for further research to be sought.
  
  
  
  This qualitative hermeneutic phenomenological study explored and interpreted Irish parents' experiences of living with and caring for children, adolescents and young adults with MPS and the impact of these diseases on their day to day life. A purposively selected sample of parents' attending the Irish National Centre for Inherited Metabolic Disorders was invited to participate in serial in-depth interviews.
  
  
  
  A total of eight parents' (n = 8) of children with a range of MPS disorders aged from 6 months to 22 years (MPS I Hurler syndrome, Scheie syndrome), MPS II (Hunter syndrome), MPS III (Sanfilipo syndrome) and MPS VI (Maroteaux-Lamy syndrome) were interviewed at three time points over a 17 month period. The main themes identified during data analysis were described as living with MPS, living with a genetic rare disease, the stigma of a rare condition, MPS as encompassing multiple diseases, Unknown future, hospital vs. home, experience of waiting, a tough road ahead, and things in their day-to-day life with MPS. They spoke of their child's Quality of Life (QoL), their healthy children's wellbeing, and for some, the impact on their own physical and psychological wellbeing. They also reflected on issues of stigmatisation and isolation in their experience of living with a child with a rare disorder.
  
  
  
  This study's findings reflect the wider literature on the impact of rare diseases, which have also indicated how caring for someone with MPS, a condition that is chronic, progressive and degenerative can impact on all dimensions of the family's life. Analysis of the findings using a hemenutic pheomenology perspecitve suggest that parents of children with MPS experience multiple cyclical movements across all five human lived existential experience, and they gradually develop ways to incorporate MPS in their day to day life. It was also evident that all the carers in this study experienced a range of uncertainties, with parents using terms such as 'no man's land' and 'future is unknown' to describe their world.
authors.affiliation: Temple Street Children's University Hospital, Dublin, Ireland. sujas@live.ie.|University College Dublin (UCD) School of Nursing, Midwifery and Health Systems, Belfield, Dublin, Ireland. sujas@live.ie.
authors.forename: S
authors.initials: S
authors.lastname: Somanadhan
authors.affiliation: Clinical Nursing (Palliative Care), Children's Nursing, All-Ireland Institute of Hospice and Palliative Care, UCD School of Nursing, Midwifery and Health Systems and Our Lady's Hospice & Care Services , Belfield, Dublin, Ireland.
authors.forename: P J
authors.initials: PJ
authors.lastname: Larkin
mesh_terms: D000293:Adolescent; D000328:Adult; D017028:Caregivers / Q000523:psychology* / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009083:Mucopolysaccharidoses; D016532:Mucopolysaccharidosis II; D009084:Mucopolysaccharidosis III; D009087:Mucopolysaccharidosis VI; D010290:Parents / Q000523:psychology*; D036301:Qualitative Research; D011788:Quality of Life; D035583:Rare Diseases; D012944:Social Support; D055815:Young Adult
keywords: Adolescent; Children; Experience; Hunter syndrome; Hurler syndrome; Maroteaux-Lamy syndrome; Mucopolysaccharidosis; Parent; Phenomenology; Qualitative research; Rare Disease; Sanfilipo syndrome; Young Adult