It’s well-known that patient recruitment is the number one challenge facing clinical trials operations, with 80% of trials having to be delayed or cancelled due to under-recruiting of patients. When a trial gets to the stage where it needs to be ‘rescued’, as a result of not recruiting enough patients in a timely fashion, here are the actions I recommend you consider for getting things back on track.
I’ve listed them here in the order you are likely to see the quickest returns – based on the time it can take to set things up and have them working effectively – with the first recommendation being the most likely to deliver results in the shortest time.
Digital Outreach Direct to Patients
Digital ads are now the mainstay of direct to patient recruitment outreach efforts, with traditional forms of advertising such as press and radio being far less used than they once were. In particular, social media advertising has become a key driver of recruitment into trials – with Facebook being the main player in the field. (Not surprisingly, given its almost 3 billion per month user base).
Other social media sites that have proven successful for recruiting patients include Snapchat (primarily to reach a younger audience), TikTok (perhaps surprisingly given its user demographic and reputation for being somewhat frivolous), and Reddit. It’s also worth looking at Google advertising (especially for rare conditions) and other forms of online promotion, such as display adverts on popular and/or relevant websites and forums.
Digital Outreach to Patient Leaders
As well as the direct approach outlined above, it’s now possible to identify Key Opinion Leaders and Patient Advocates through such activities as ‘social listening’. This is where we analyse the conversations that are taking place online in order to identify the best platforms and people to approach for promoting trial enrolment. These Key Opinion Leaders should have a readymade audience of potential trial participants they can promote the trial to.
Social media sites, such as those featured in the Direct to Patients sectin above, can be a valuable source for finding Key Opinion Leaders and Patient Advocates that we can approach to promote trials that need to pick up their recruitment activity.
Digital Outreach to HCPs
Healthcare Professionals (HCPs) should really be a good source of patients for trials, as they obviously see people with relevant conditions on a regular basis. However, due to time constraints within doctor’s appointments and general lack of awareness of specific trials, it’s quite often the case that HCPs don’t provide as many patients as originally anticipated.
One method of encouraging doctors to bring up the idea of trial participation with their patients is to reach out to them at the right time, with the right message. Utilising lab test and medical claims data (in the USA), we can identify HCPs who have patients with the relevant condition and send them a targeted message about the trial that their patient may be interested in. Using a dedicated HCP Outreach platform can be very useful here, allowing us to target doctors using their preferred means of communication – e.g. via email, or on a website they habitually frequent.
LinkedIn and Twitter can also be useful platforms for targeting HCPs. Both these sites have decided not to allow direct promotion of clinical trials, but can be used for sourcing and engaging with medical professionals who operate in the relevant field.
Widening the Recruitment Pool
Within the industry, there’s been much discussion about Decentralized Trials (DCTs)over the last few years – particularly since the onset of the Covid pandemic in 2020. While DCTs are not suitable for every trial, it’s well worth considering a decentralized approach where it could significantly increase your target audience and thus aid recruitment.
Traditionally, patients have had to attend a Research Site at regular intervals during a trial. This can limit the audience to those people within travelling distance of their nearest Site. (Often defined as being those people who live within 50-60 miles). Opening up the trial through decentralization allows a much broader audience to be targeted and recruited – for which there are multiple solutions for conducting the necessary ‘Site visits’ from within a patient’s home, or at their local doctor’s surgery.
As well as decentralization, offering a travel and accommodation solution can also increase the size of the potential audience of patients. This can be particularly effective if the solution is offered as a ‘done for you’ package, rather than having the patient sort out their own arrangements and have to claim back their expenses.
Another method of widening the recruitment pool is to ensure your recruitment efforts are underpinned by the principles of diversity and inclusion. This can include such factors as incorporating images of people from diverse backgrounds, as well as having your messaging in different languages and being presented to people who live in particular areas or have specific interests – especially in the case of underrepresented populations who may not ordinarily consider taking part in a clinical trial.
Improving Site Performance
During the recruitment stage of a clinical trial, you will usually find there are some Research Sites that perform better than others – with many at the lower end of the scale actually recruiting no patients at all. The site selection process can help with this in the trial setup stage – i.e. through choosing Sites that are more likely to be able to deliver the desired results. But it can obviously take time to bring new Sites on board, so improving the performance of the Sites already involved in recruiting for the trial can speed up the process.
One key element here is to identify the best practices that the high-performing Sites are using, then have the other Sites adopt them in place of what they had been doing previously. A consultative approach to working with each of the Sites engaged in the trial will work best here for optimal results.
How to accelerate the recruitment process is a key issue for the majority of clinical trials. If you’d like to know more about the solutions on offer, get in touch to explore the possibilities.