The $8m Question - Why and When Patients Leave the Recruitment Journey
TrialWire is a Digital Patient Recruitment Platform custom-built on Salesforce Health Cloud that can start recruiting in under 24 hours. It has prioritized security and patient privacy while leveraging the latest algorithm and AI technology to rapidly match patients with studies. TrialWire engages with patients in real-time online when they are researching medical conditions so they are motivated and highly responsive. TrialWire allows eligible people to find and connect with their nearest participating site in less than a minute. Study Coordinators, Sponsors, and CROs have private and secure Dashboards showing relevant patient referral updates. Study Coordinators also have a built-in SMS system to quickly connect with patients. TrialWire successfully recruits for site-based and DCT studies in APAC, EU, Canada and the US.
With up to $8m at risk per day due to a failed recruitment strategy, knowing why and when patients leave the enrollment journey is vital.
Typically studies rely on sites to find and deliver patients. However, given the significant time and cost risks of recruitment delays many Sponsors and CROs are also implementing a digital solution that can deliver patients to sites quickly if a study stalls.
With more than 80% of studies failing to meet recruitment timelines, starting a study with proactive recruitment strategy options mitigates study risk. In addition, knowing in advance why and when patients might leave the recruitment journey is key to avoiding or stemming losses and getting recruitment back on track.
Unlike traditional recruitment alternatives, a digital recruitment approach offers real-time and detailed measurement and tracking of the patient journey. Data from TrialWire recruitment programs have informed the following guidelines for a successful patient journey.
Patient Journey Guide
While every study is different with specific eligibility and exclusion criteria that requires a unique type of patient, there are loss management strategies relevant to all studies that can vastly improve recruitment and enrollment.
Understanding patient motivation for joining a study is key to recruitment success. TrialWire data shows people join clinical trials for a variety of reasons including seeking:
- a cure
- symptom relief
- a medication or treatment alternative
- expert check-ups
- medical tests
- access to medical attention they can’t normally afford
- study reimbursement
- to give back and help contribute to medical knowledge
Tapping more than 20 years of patient recruitment experience as well as de-identified behavioral data from the TrialWire Platform, we have identified 10 key factors that undermine successful recruitment. All of which can be easily addressed.
- Finding the Right People
Traditional advertising strategies can be expensive, non-targeted and deliver phone calls to sites that take up valuable time and most are not productive. Algorithm and AI digital systems can quickly find and screen the right people geotargeted near sites, or for DCTs.
- Trust and Online Screening
People are hesitant about sharing their personal information unless they are eligible for a study. Recruitment websites that ask for patient contact details upfront before sharing information about a study or eligibility status result in high drop-out rates. This means the study misses out on valuable potentially eligible patients. This type of website screener is typically a database builder tool that reshares/resells patients to multiple studies. (TrialWire is not a database service.)
- Patient Privacy
Be very clear about how their data is going to be used, where it is being sent, and confidentiality assurances. People are already hesitant about sharing their private health information with an online service so a detailed privacy declaration supports engagement.
- The Process
Clearly articulate next steps – if a study coordinator is going to call, SMS or email, include that in the next steps. Also if they are required to visit a site for screening or it involves a home visit or a home delivery of the study medication etc., explain all of this in detail.
- Financial Reimbursement
Avoid mentioning reimbursement other than travel and other minor costs because it can potentially motivate and attract the wrong sort of patient. (This does not apply to healthy volunteer studies.)
- Built for mobile
Online engagement should be specifically designed for mobile because TrialWire data shows more than 90% of recruitment is via mobile – even for older person studies (older people tend to also use tablets). Online forms need to be custom designed for mobile with larger selection buttons and fonts etc.
- The Map
Avoid sending eligible people to a map to search for their nearest site. People prefer to have the process managed so they just add their city/state and their nearest site appears with a contact option. In addition, map systems on mobiles can render differently and be difficult to manage.
- Overloading Sites
A recruitment strategy should prioritize managing patient referral numbers to sites. It needs to be flexible enough to turn on or off for a site depending on their capacity. A patient ideally needs to be contacted within 72 hours to maximize engagement.
- Site Feedback
Regular feedback from the sites can deliver real breakthroughs in recruitment. Sites have insights into patient types, trends, motivations and more so this is important to incorporate in a recruitment strategy.
- Site/Patient Contact Process
Ideally patients give a contact time preference in their application. Sites should be encouraged to contact people by phone within 72 hours of an application, and be prepared to make up to 5 calls per person (at different times). They should leave a message with their name and title and organization and that they are responding to an application sent to them by this person. Their voice mail on the site phone should have the same name and title and organization so when a patient calls back they get validation that this is a legitimate caller. Ideally sites should SMS patients and arrange a time to talk (TrialWire Dashboards have this capability).
If they are sending an email to a patient keep it simple, with a quick introduction including study name and study coordinator name and organization. Sending forms or brochures to sign or review can complicate the process – the aim is to talk to them first, answer questions then follow-up with information.
About the Author
Susan Fitzpatrick-Napier has decades of experience working with biotechs, pharma, CROs, biolabs, and health and clinical research companies in US, EU, Singapore, Hong Kong and Australia in roles including digital communications director and patient recruitment strategist. TrialWire has offices in San Francisco, Singapore, and Sydney.