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As well as advertising, there are other methods of finding patients to take part in trials.

I’ve always liked the idea of having Healthcare Professionals (HCPs) introduce trials to their patients – being already in a position of trust. Unfortunately, this method doesn’t usually work all that well, but can be worth it if you get an influential HCP on board to promote the trial.

Patient databases and patient advocacy groups are another method of reaching your target audience – especially if you can offer them something of value, such as unique information related to their condition.

A few ways of expanding your potential audience beyond the travel radius of the participating research sites include: the use of mobile sites to bring the trial to previously underserved populations, providing home visits by trial nurses, or offering to cover travel and accommodation costs.

Finding patients for clinical trials is probably the most difficult of the 4 elements that go into patient recruitment, so I’ve put together 2 videos to outline what’s involved.

One of the main methods is what’s known as ‘Direct To Patient’. Which means reaching out to potential trial participants directly, through such methods as advertising.

The main way to achieve this over the last 7 or 8 years has been through ads on social media – primarily Facebook – where you can target by demographic information such as location and age. Other platforms that can be useful include Instagram, Snapchat – for a younger audience – and even TikTok.

Traditional advertising methods, such as press and radio, can also still be effective for reaching a particular audience. As can getting your message onto relevant podcasts.

I’ll introduce some other methods of finding patients in the next vid.

So how do we go about recruiting patients for clinical trials? There are 4 key elements to consider.

Firstly, finding the patients. We need to go out and look for relevant people, so locating them in the first place is a primary concern.

Secondly, engaging with them. Once we’ve found our audience of potential trial participants, we need to give them good reasons to want to take part.

Thirdly, qualifying the patients. Each trial will have its own Inclusion/Exclusion criteria. As far as possible, we want to pre-qualify patients that are suitable, before sending them to a research site for full screening.

And fourthly, retaining them on the trial. We want to have engaged, enthusiastic trial participants who will stay in the trial to completion.

In the next few vids, I’ll expand on each of these elements.

I was at the House of Lords recently, and it got me thinking that what that second chamber does for parliament is similar in function to something I recommend to organizations running clinical trials. Which is to have someone oversee and scrutinize their patient recruitment and clinical operations activities to ensure best results.

Having a ‘second pair of eyes’ look over what you’re doing – and, in the case of clinical operations, also what your service providers and vendors are doing – can be very valuable for spotting errors or highlighting things that should work better if done differently.

In the same way that many members of the House of Lords have experience in relevant fields for the laws and parliamentary bills they work on, I recommend anyone involved in managing clinical trials should bring in experienced independent ‘outsiders’ to review and oversee their trial activities.

While recruiting people into a trial is the single biggest problem, retaining them throughout the trial’s lifespan is another major issue. Which, in turn, leads to additional recruitment activity being required in order to replace them.

There are multiple reasons that people give for dropping out of a trial. Many of them related to the burden of participation – such as the number and frequency of visits to the research site, the length of time it takes to travel to and from the site, and the overall time commitment involved in ongoing participation. All of which can lead to ‘appointment fatigue’.

Another important factor is the extra stress that patients may feel themselves to be under while taking part in a trial. Which can be especially problematic for the many patients who will already be living with chronic conditions that make their lives difficult in the first place.

Over the time I’ve been involved in the industry, clinical trials have witnessed an increase in complexity in terms of their execution – where multiple site visits for patients have become the norm. Sometimes even before they are accepted into the trial. Additionally, there can often be a need for the patient to maintain ongoing records of their well-being and response to the prospective treatment. Which places a significant burden on the participant. Who, after all, is a volunteer in the process.

Perhaps most significantly, the inclusion and exclusion criteria for trials have grown more intricate, demanding very specific criteria to be met in order to qualify for participation. This inevitably narrows the potential pool of participants – which may already be quite limited, especially in the case of trials focused on rare diseases.

Patient-facing materials can also be excessively complex and challenging to comprehend, potentially resulting in a decline in interest from individuals who may otherwise be willing to participate.

Another major challenge for patient recruitment is the lack of access to trials. The vast majority of trials are conducted at Clinical Research Sites. These are often large institutions such as universities or hospitals that are located in urban areas.Which limits participation to individuals who can conveniently travel to these specific locations – often defined as a radius of around 50-60 miles from a Site.

There are also smaller Research Sites that conduct trials – which are usually either dedicated sites or private medical practices seeking to generate additional revenue. However, in the same way as with the larger Sites, these smaller venues also face the limitation of attracting patients who can conveniently travel to their premises.

As well as travelling, of course, the time commitment required to take part in a trial poses an additional hurdle – as prospective participants must juggle their existing responsibilities, such as work or other commitments, with attending trial appointments.

The primary challenge for patient recruitment is that of awareness. With the majority of people being simply unaware of the existence of clinical trials they could participate in.

While the Covid pandemic did go some way to increasing awareness about trials, there remains a significant lack of knowledge regarding trials for non-Covid conditions. So while people knew there were trials for Covid vaccines, they didn’t necessarily relate that to the idea that there might be trials for other conditions.

Another notable issue is that healthcare professionals, who you would think would be ideally placed for introducing trials to patients, often themselves lack awareness of relevant trials. And their limited inclination to explore trials is further constrained by the time pressures of patient appointments.

Also, patients typically do not actively seek out trials for themselves. Such that the industry relies quite heavily on targeted messaging, such as through digital advertising, to reach potential trial volunteers.

I’m a believer that if you do what you’ve always done, you’ll get what you’ve always got. I seem to be in a minority in this belief within the clinical trials industry, though, as the same old patient recruitment tactics get wheeled out for every new trial.

I think the reason for this is a fear of doing something that strays outside the type of strict conduct necessary for successful clinical research. But that’s where I suggest there’s a fundamental error being made.

To my mind patient recruitment is a marketing activity, not a clinical one.

Obviously a clinical approach is necessary in the lab. But when it comes to attracting people to participate in the first place, it’s exactly that clinical approach that leads to 90% of trials not recruiting on time.

And it’s this fundamental shift in mindset – from clinical to marketing – that helps enable the development of more creative approaches to the problems of patient recruitment.