Research ethics

Malawians permit research bronchoscopy due to perceived need for healthcare

¹ Wellcome Trust Research Laboratories, Universities of Malawi and Liverpool, Blantyre, Malawi
² Department of Medicine, University of Malawi College of Medicine, Blantyre, Malawi
³ Liverpool School of Tropical Medicine, Liverpool, UK

Correspondence to:
Dr S Gordon, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; sbgordon{at}liverpool.ac.uk

Objectives: Bronchoalveolar lavage obtained at bronchoscopy is useful for research on pulmonary defence mechanisms. Bronchoscopy involves some discomfort and risk to subjects. We audited the process of consent, experienced adverse effects and reasons for participation among research bronchoscopy volunteers.

Design: 100 consecutive volunteer research subjects attending for bronchoscopy, repeat bronchoscopy or routine recruitment clinic were interviewed. Information was gathered about volunteer motivation, perception of the consent process and adverse effects of bronchoscopy. Suggestions for improvement were requested. Responses were themed by a second investigator prior to data analysis.

Results: 81 bronchoscopy-experienced subjects (total of 263 procedures) and 19 new volunteers were interviewed. 19 subjects (21%) reported adverse symptoms during or after bronchoscopy, but no symptoms were of sufficient severity that they would not repeat the procedure. The frequency of symptoms was not related to gender, the quality of the lavage or the HIV status of the subject. 76 subjects (94%) reported that the information given pre-procedure was useful and adequate but 43 (56%) had further questions mostly relating to their own results. The reasons given for research participation were access to health assessment (75 subjects), access to treatment when ill (61 subjects), desire to participate in research (15 subjects) and remuneration (6 subjects). 7 subjects complained that the remuneration was inadequate.

Conclusions: The main incentive to participation in research bronchoscopy was access to healthcare. Informed consent and procedure technique were adequate but subjects would value more feedback about individual and project results.

Keywords: bronchoscopy (subterms: adverse effects, complications, contraindications, education, immunology, methods); bronchoalveolar lavage; research; ethics

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