title: Response to written feedback of clinical data within a longitudinal study: a qualitative study exploring the ethical implications.
abstract: BACKGROUND
  There is a growing ethical imperative to feedback research results to participants but there remains a striking lack of empirical research on how people respond to individualised feedback. We sought to explore longitudinal study participants' response to receiving individual written feedback of weight-related and blood results, and to consider the balance of harms against benefits.
  
  
  METHODS
  A qualitative study with face-to-face and telephone interviews conducted with 50 men and women who had participated in the fifth and most recent wave of the cohort study 'West of Scotland Twenty-07' and received a feedback letter containing body mass index (BMI), body fat percentage, cholesterol and glycated haemoglobin A1c (HbA1c) results.
  
  
  RESULTS
  Expectations of, and response to, the feedback of their individual results varied. Whilst half of the participants were on the whole 'pleased' with their results or held neutral views, half reported negative responses such as 'shock' or 'concern', particularly in relation to the weight-related results. Participants who were overweight and obese used the most negative language about their results, with some being quite distressed and reporting feelings of powerlessness, low self-image and anxiety over future health. Nevertheless, some people reported having implemented lifestyle changes in direct response to the feedback, resulting in significant weight-loss and/or dietary improvements. Others reported being motivated to change their behaviour. Age and gender differences were apparent in these narratives of behaviour change.
  
  
  CONCLUSIONS
  The potential harm caused to some participants may be balanced against the benefit to others. More evaluation of the impact of the format, content and means of individualised feedback of research findings in non-trial studies is required given the growing ethical imperative to offer participants a choice of receiving their results, and the likelihood that a high percentage will choose to receive them.
authors.affiliation: MRC/CSO Social and Public Health Sciences Unit, 4 Lilybank Gardens, Glasgow G12 8RZ, UK.
authors.forename: Karen
authors.initials: K
authors.lastname: Lorimer
authors.forename: Cindy M
authors.initials: CM
authors.lastname: Gray
authors.forename: Kate
authors.initials: K
authors.lastname: Hunt
authors.forename: Sally
authors.initials: S
authors.lastname: Wyke
authors.forename: Annie
authors.initials: A
authors.lastname: Anderson
authors.forename: Michaela
authors.initials: M
authors.lastname: Benzeval
mesh_terms: D000273:Adipose Tissue; D000328:Adult; D001007:Anxiety / Q000523:psychology; D015992:Body Mass Index; D002784:Cholesterol / Q000097:blood; D032984:Ethics, Research; D030141:Feedback, Psychological; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008137:Longitudinal Studies / Q000941:ethics*; D008297:Male; D008875:Middle Aged; D058028:Research Report; D018570:Risk Assessment; D014342:Truth Disclosure
chemical_list: D002784:Cholesterol; D006442:Glycated Hemoglobin