title: Understanding Ethical Issues of Research Participation From the Perspective of Participating Children and Adolescents: A Systematic Review.
abstract: BACKGROUND
  The past 20 years have seen distinct shifts in the way the participation of children and adolescents in research is viewed. This has been emphasized by the growing pediatric research enterprise. Additional information on children's and adolescents' experiences during research participation is needed to better inform researchers on the ethical conduct of research with this vulnerable population.
  
  
  OBJECTIVE
  The objective of this analysis was to examine ethical issues in research with children and adolescents from their perspective as participants, including: assent, parental consent, risk perception, impact of research participation, and incentives.
  
  
  METHODS
  This systematic review was conducted per the Long, Godfrey, Randall, Brettle, and Grant framework by means of an iterative searching process. Using the key words "research ethics" and "child or pediatric or adolescent," PubMed, CINAHL, and EBSCOhost databases were searched to identify articles. Limitations placed on the searches were: English language, year of publication between 2003 and 2014, humans, abstract available, and age birth-18 years.
  
  
  RESULTS
  Twenty-three empiric studies were identified and formed the sample. Included studies represented a diverse range of areas of research, methods, settings, sample demographics, authors, and journals.
  
  
  CONCLUSIONS
  Even young children demonstrated the ability to understand essential elements of research, although there is variability in children's level of understanding. Trust was a significant contributing factor to children's and adolescents' participation in research, and also shaped their assessments of risk. Research participation was mainly beneficial for children and adolescents. Incentives were mainly viewed positively, although concerns of possible undue influence were expressed.
authors.affiliation: Predoctoral Fellow, Indiana University School of Nursing, Indianapolis, IN, USA.
authors.forename: Stacey
authors.initials: S
authors.lastname: Crane
authors.affiliation: Ruby F. Wilson Distinguished Professor and Dean, Vice-Chancellor for Nursing Affairs, Duke University School of Nursing, Durham, NC, USA.
authors.forename: Marion E
authors.initials: ME
authors.lastname: Broome
mesh_terms: D000293:Adolescent; D002648:Child; D032984:Ethics, Research; D006801:Humans; D010465:Perception; D035842:Research Subjects; D035502:Trust
keywords: adolescent; assent; child; consent; ethics; incentive; participant; participation; research; risk