Objective: The lack of adequate conceptualisation and operationalisation of quality of life (QoL) limits the ability to have a consistent body of evidence to improve QoL research and practice in informal caregiving for people with Multiple Sclerosis (MS).Thus, we conducted a meta-synthesis of qualitative research to improve the conceptual understanding of the experiences of MS carers and to identify factors that affect carers' QoL.Design: Systematic searches of five electronic databases yielded 17 qualitative studies which were synthesised using the principles of meta-ethnography.Results: The synthesis resulted in 9 inter-linking themes: Changes and losses; challenges revolving around MS; caregiving demands; burden of care; future concerns; external stressors; experiences of support; strategies used in managing the caregiving role; and motivating factors. Our findings suggest that MS carers can have both positive and negative experiences which may bring challenges and rewards to the carers.Conclusion: We present a proposed QoL model for MS caregiving which can be used to inform the development of interventions for MS carers to improve their QoL.However, further empirical research is needed to examine the utility of this model and to explore the concept of QoL in MS carers in more detail.Keywords: informal carers; meta-ethnography; meta-synthesis; multiple sclerosis; quality of life Multiple Sclerosis (MS) is one of the most common chronic neurodegenerative diseases among adults, globally affecting approximately 2.3 million individuals (Multiple Sclerosis International Federation [MSIF], 2013). MS has an extremely variable progression, with some patients showing a steady rapid deterioration (i.e. primary progressive course), and most experiencing unpredictable exacerbations and remissions of symptoms (i.e. relapsingremitting course; Mohr et al., 1999).
3In the later stages of MS and at times of exacerbations, people with MS (pwMS) cannot manage daily living activities by themselves and can become functionally dependent on others. Generally, it is the immediate family members (e.g. spouse) or friends who take on the responsibility of caring for pwMS (Forbes, While, & Mathes, 2007), and are commonly referred to as 'carers' or 'caregivers'. A carer is someone who provides a significant amount of voluntary unpaid support and help to a friend, relative, or a neighbour, who suffers from an illness, disability, frailty, mental health problem, or addiction (Carers Trust, 2012;Carers UK, 2015; Department of Health [DoH], 2014). The word 'informal' is commonly used to distinguish voluntary unpaid carers from health professionals or care workers who get paid for providing care.As a result of the progressive, unstable and unpredictable nature of MS, caring for pwMS causes high levels of carer burden and is recognised as a potential threat to caregivers' health and well-being (Corry & While, 2009;Devins, Seland, Klein, Edworthy, & Saary, 1993). Indeed, there is consistent evidence in the current literature that overall qual...