The last couple of years have seen a significant increase in awareness of the existence of clinical trials among people all over the world. No prizes for guessing the reason, but how can we capitalize on this heightened awareness to tackle the perennial problem of not being able to recruit enough patients to participate in trials?
Based on my extensive experience and the developments I’ve been following over the years, I’ve put together an overview of the patient recruitment activities that are likely to be most effective in 2022 and beyond:
Using an HCP outreach platform to target doctors with relevant messaging is especially useful when recruiting patients for rare disease trials. Utilizing lab test and/or medical claims data (in the USA) can help identify HCPs who have patients that may be suitable – for example, those who have been submitted for a specific test for a rare oncology mutation. Reaching out to them in a timely manner via email, digital advertising, and even old-fashioned postal mail can help put your trial at the ‘top of mind’ and encourage them to discuss the trial with their patients.
Other methods of HCP outreach include targeting people with relevant specialisms on LinkedIn. This platform doesn’t allow direct promotion of clinical trials, but through using an advert type such as a Lead Generation Form you can start to engage in a dialogue with doctors who would then be more amenable to hear about and promote your trial.
Digital Outreach – Direct to Patients
Reaching people ‘where they are’ is a fundamental principle of marketing. And people are spending more time than ever online, particularly on social media platforms. Despite its well-publicised issues over the last few years, Facebook remains the number one visited social media site in the world, with nearly 3 billion users each month. Its sophisticated machine learning capabilities ensure it’s always worth looking at Facebook ads for trial recruitment. (For more on this, you might want to check out my book on Patient Recruitment for Clinical Trials using Facebook Ads).
But it’s not just about Facebook – many other social media sites have proven to be effective for patient recruitment, including SnapChat, Reddit, Instagram and even TikTok. Plus, of course, Google and YouTube can provide a large audience of potential trial participants, as well as the many other methods of reaching people online. (e.g. ‘native advertising’ on news and information websites, or ads on forums and health-related sites).
It should also be remembered that HCPs use social media, too, so your digital adverts have an additional chance of being effective for recruitment – through targeting patients directly as well as showing your message to doctors who may be interested in learning more.
Relationships with Patients and KOLs
One of the great benefits of the increased use of digital solutions in healthcare over the last 2-3 years is the development of tools that are genuinely useful for the purpose of trial recruitment. One such tool enables us to use ‘social listening’ to identify the platforms and individuals who are most active in discussing relevant topics for the condition we’re recruiting for. This can help us to identify, for example, that Reddit has a larger population of people discussing our condition than are active in Facebook Groups. Many of these people will belong to Patient Advocacy Groups (or be Patient Advocates) and may well be Key Opinion Leaders whom it’s worth our starting a dialogue with to discuss a relevant trial.
Building relationships with Patients, PAGs and KOLs is a very human activity that can be facilitated through using a relevant digital tool for identifying and reaching out to the people best placed to help promote our trials.
Traditional Media and Podcast Awareness Campaigns
It’s true that traditional forms of advertising, such as press and radio, are decreasing in effectiveness when it comes to recruiting patients. But they can still be a valuable part of the overall mix for raising awareness of a trial. As can a PR and publicity campaign through media such as podcasts. There are many general and health-related podcasts that will accept advertising – often in the form of the host reading out the message during the show. Plus many KOLs and Patient Advocates will host their own podcasts, on which they may be happy to promote a relevant trial.
Patient Application Platform
Having an effective and efficient patient application platform in place is of great benefit for the smooth running of the trial recruitment process. The platform should include an online application website/webpage (also accessible on mobile) where potential participants can be pre-screened for the trial. The backend of the system should be robust and sophisticated enough to host the applicants’ data in a secure manner that fits all the relevant regulations (GDPR, HIPAA etc.), as well as providing snapshot reports of activity, number of applications, stage the applicants are at etc.
Using a platform in this manner can ensure that no patients ‘slip through the net’, as well as giving a good overview of which promotional activities are working best, which regions might need some assistance to improve performance, how you might be able to increase conversion rates etc.
Swift Follow-Up for Patient Applications
Once potential trial participants have completed the online pre-screener form, a swift follow-up with them is essential for maximising the number of patients who qualify for the trial. Digital methods are available where, for example, a series of text messages is sent to consolidate the application. What has often been seen to work best of all, though, is a follow-up phone call from a medically-trained person (such as a nurse), who can go through additional screening questions based on the trial’s inclusion/exclusion criteria.
Diversity Equity and Inclusion
Increasing trial participation from underrepresented populations has long been an issue in the industry. Thanks to initiatives such as the FDA’s guidance on enhancing diversity, trials are increasingly moving towards a situation where people of all backgrounds are being encouraged to take part. This not only makes sense for better outcomes – i.e. developing treatments that work for everybody, not just a particular type of person – it helps to widen the potential audience from which to recruit. There is definitely work that needs to be done here to reduce the mistrust among certain populations, but incorporating a DEI mindset when developing your recruitment program will help speed up recruitment and deliver better results for society as a whole.
Best Practice Education
Using a suitable Patient Application Platform, it’s possible to identify those Research Sites that are doing well and those that are doing badly for recruiting patients. It makes sense to work with the best performers to identify best practices – i.e. what it is they’re doing that’s working well – which can then be passed on to the Sites that aren’t performing as well. This not only helps speed up recruitment, it also keeps the lower performing Sites engaged in the process and more likely to be able to deliver good results for future trials.
Research Site Assistance and Liaison
People working in Research Sites are generally busy with lots of administrative things they need to do, so helping them by making the admin for the patient recruitment process simple will help keep them interested in managing your trial. Having a suitable Patient Application Platform that is easy to use and integrates with their existing systems, with little or no need for in-depth training, will be very valuable here.
Further to this, regular communication with the Research Sites will help keep the trial ‘front of mind’ and ensure that each patient referred to them is handled swiftly and appropriately.
Patient Data and Patient Registries for Region, Site, and Patient Identification
Another use for some of the digital tools that have been developed in recent years is for better analysis of data on patient populations, using data from Healthcare Providers, Electronic Health Records, and Patient Registries. This can help to determine the regions where you can find the maximum number of patients for your trial, based on the condition and inclusion/exclusion criteria. This data analysis can also help identify specific Research Sites that are likely to have patients living nearby, as well as provide access to a readymade audience of potential trial participants.
Patient-Friendly Trial Design
Increasingly in recent years trial protocols have often become so restrictive they make recruiting patients even harder than it already is. There are obviously good reasons for this, but it’s also far too often the case that previous protocols are ‘copied and pasted’ without determining whether they are entirely relevant for the new trial. Removing some excessive strictness from the inclusion/exclusion criteria can help open up the trial to a wider audience.
Having an arduous and time-consuming routine for participating in a trial can also be an issue for recruitment, as it can put people off wishing to take part. With the development of wearable tech and the more widespread acceptance of digital meetings (rather than having to meet in-person), it’s possible to reduce the burden on the patient so they don’t have to spend so much time attending Research Sites while on the trial.
One of the great buzzwords in clinical trials for many years now, Decentralized Trials have become an even hotter topic during the pandemic. The ability to manage and monitor a patient on trial without them having to be physically in attendance at a Research Site helps open up the potential audience to people who live outside a 50-60 mile radius of a participating Site.
Lots of solutions have been developed to help with the proliferation of Decentralized Trials, including those that allow patients to attend their local doctor’s surgery, rather than a Research Site, through having a simple digital system in place at the surgery. The Principal Investigator can then conduct the trial in the manner they need to – including having any nurse-specific tests carried out by the local practice – without the patient having to be present in their Site. Principal Investigators benefit from this approach by gaining additional patients for the trial, while the local doctors benefit through having an extra income stream they wouldn’t have had otherwise.
Travel and Expenses
In circumstances where Decentralization isn’t practical, being able to provide transportation and expenses for patients can help encourage more people to participate in your trial. A simple solution such as a concierge service that arranges travel and/or a pre-paid card for expenses can work best here for making things as easy as possible for the patient. This also helps with ongoing trial retention, as patients know they are not going to have the ongoing hassle of arranging their own travel or accommodation each time they need to attend a clinic.
Retention Through Communication
While it’s a well-known fact that 80%+ of clinical trials have to be delayed or closed due to not recruiting enough patients, it’s also the case that up to 30% of patients who do enrol will drop out over the course of the trial. Retaining patients throughout is thus a key factor in ensuring your trial hits its milestones.
Good communication is the key to retaining patients on trials – both through the messages that are sent and through the mediums that are used. Some people will prefer to have regular text messages, some will prefer emails, others will prefer phone calls, and some will even prefer postal mail. Having each of these available as a means of keeping in touch – alongside clear, patient-friendly messages and responses – will help retain more patients on your trials.
Patient Recruitment Strategy
In order to make best use of the activities outlined above – not all of which will be suitable for every trial – you should develop a strategy that is tailored for the specific trial and patient population concerned. My specialism is in working with you to determine which of these elements will work best for your trial, then managing them and the ongoing recruitment process for maximum returns.
Get in touch to see how I can help recruit patients for your trial, in 2022 and beyond