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.

1. 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.

2. 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.)

3. 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.

4. 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.

5. 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.)

6. 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.

7. 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.

8. 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.

9. 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.

10. 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.