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Ethics and patient and public involvement with children and young people
  1. Sarah Jane Mitchell1,
  2. Anne-Marie Slowther1,
  3. Jane Coad2,
  4. Shazaan Akhtar3,
  5. Elizabeth Hyde4,
  6. Dena Khan4,
  7. Jeremy Dale1
  1. 1 Warwick Medical School, University of Warwick, Coventry, UK
  2. 2 Faculty of Health and Life Sciences, Coventry University, Coventry, UK
  3. 3 Birmingham Children’s Hospital Young Persons Advisory Group, Birmingham Children’s Hospital, Birmingham, UK
  4. 4 NIHR CRN Young People’s Steering Group, Stafford, UK
  1. Correspondence to Dr Sarah Jane Mitchell, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; S.Mitchell6{at}


Patient and public involvement (PPI) is important both in research and in quality improvement activities related to healthcare services . While PPI activities do not require formal ethical approval, they can raise a number of ethical concerns, through the introduction of complex technical medical concepts, challenging language or sensitive subject areas. There is very little published literature to guide ethical practice in this area. We have been conducting PPI with children and young people throughout a research study in paediatric palliative care. PPI started during the application process and continued to guide and shape the research as it progressed. Ethical issues can arise at any time in PPI work. Although many can be predicted and planned for, the nature of PPI means that researchers can be presented with ideas and concepts they had not previously considered, requiring reflexivity and a reactive approach. This paper describes how we considered and addressed the potential ethical issues of PPI within our research. The approach that emerged provides a framework that can be adapted to a range of contexts and will be of immediate relevance to researchers and clinicians who are conducting PPI to inform their work.

  • palliative care
  • patient perspective
  • paediatric practice
  • health services research

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  • Contributors SJM, AMS, JC and JD conceptualised the article. SM led on writing of the manuscript. SN, EH and DK reviewed the manuscript for relevance and context. AMS, JC and JD reviewed the manuscript for intellectual content. All authors edited the final manuscript.

  • Funding This work is supported by a National Institute of Health Research Doctoral Research Fellowship (Dr Sarah Mitchell DRF-2014-07-065).

  • Disclaimer This article presents independent research funded in part by the National Institute for Health Research (NIHR). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.