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父母与患有黏多糖贮积症(MPS)的儿童、青少年及青年共同生活并照顾他们的经历。

Parents' experiences of living with, and caring for children, adolescents and young adults with Mucopolysaccharidosis (MPS).

作者信息

Somanadhan S, Larkin P J

机构信息

Temple Street Children's University Hospital, Dublin, Ireland.

University College Dublin (UCD) School of Nursing, Midwifery and Health Systems, Belfield, Dublin, Ireland.

出版信息

Orphanet J Rare Dis. 2016 Oct 10;11(1):138. doi: 10.1186/s13023-016-0521-0.

Abstract

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

摘要

背景

许多儿童罕见病会危及生命且长期使人衰弱,因此,对患者及其家庭来说,与罕见病共存是一项持续的挑战。黏多糖贮积症是一系列罕见的遗传性代谢紊乱疾病之一,属于3类危及生命的疾病,目前尚无治愈方法。尽管对罕见病的研究日益新颖,且对人群具有临床重要性,但该领域缺乏支持政策和战略制定的实证数据,这有力地证明了需要进一步开展研究。

方法

这项质性诠释现象学研究探索并解读了爱尔兰父母与患有黏多糖贮积症的儿童、青少年及青年共同生活并照顾他们的经历,以及这些疾病对他们日常生活的影响。我们邀请了有目的地选取的、前往爱尔兰国家遗传性代谢紊乱中心就诊的父母样本参与系列深度访谈。

结果

在17个月的时间里,我们在三个时间点对8位父母进行了访谈,他们的孩子患有不同类型的黏多糖贮积症,年龄从6个月到22岁不等(黏多糖贮积症I型Hurler综合征、Scheie综合征)、黏多糖贮积症II型(Hunter综合征)、黏多糖贮积症III型(Sanfilipo综合征)和黏多糖贮积症VI型(Maroteaux-Lamy综合征)。数据分析过程中确定的主要主题包括与黏多糖贮积症共存、与遗传性罕见病共存、罕见病的污名、黏多糖贮积症包含多种疾病、未知的未来、医院与家庭、等待的经历、前路艰难,以及他们与黏多糖贮积症相关的日常生活。他们谈到了孩子的生活质量、健康孩子的幸福,对一些人来说,还谈到了这些疾病对他们自身身心健康的影响。他们还反思了在与患有罕见病的孩子共同生活的经历中所面临的污名化和孤立问题。

结论

本研究的结果反映了关于罕见病影响的更广泛文献,这些文献也表明,照顾患有黏多糖贮积症这种慢性、进行性和退行性疾病的患者会如何影响家庭生活的方方面面。从诠释现象学的角度对研究结果进行分析表明,患有黏多糖贮积症孩子的父母在人类生活的所有五个生存体验维度上都经历了多次循环往复,并且他们逐渐找到了将黏多糖贮积症融入日常生活的方法。同样明显的是,本研究中的所有照顾者都经历了一系列的不确定性,父母们用“无人区”和“未来未知”等词来描述他们的世界。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c86d/5057247/28d4fde83659/13023_2016_521_Fig1_HTML.jpg

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