When I first became involved in the world of recruiting patients for clinical trials, it always surprised me how ineffective the process was, given the amount of funding available and obvious capabilities of the people in the industry.
One of the first clients for my original digital marketing service – back in 1998 – was a doctor looking to increase the number of patients for his private practice. Not surprisingly, I went ahead with a strategy of building him a website, then promoting it to people in the local area using relevant means. (SEO, local directories etc). This approach was successful and led to a number of enquiries from new patients.
Which is why, more than ten years later, I was surprised by the somewhat old-fashioned approach to patient recruitment that I saw being adopted by people in the clinical trials industry. Indeed, even now, in 2022, it’s still a fairly common practice for a patient recruitment campaign to proceed without incorporating an online presence and application method.
I’m also a believer in the maxim: ‘do what you’ve always done, get what you’ve always got’ – another reason why I was surprised that the industry continued to base its patient recruitment activities on methods that had consistently under-performed.
My entry to the world of clinical trials came via my expertise with digital marketing. Which at least showed that progress should be possible as some organisations had eventually picked up on the fact that people were spending more time online than reading newspapers. Leading to them turning to the digital realm – and social media in particular – to try to attract trial participants.
But, in order to improve the situation, it’s not simply about reacting to people’s changing behaviours and trying to utilize newer methods of communication. The whole field of patient recruitment and retention has been held back through having it treated fundamentally as a clinical function, rather than a marketing one.
Understandable, of course. Clinical research obviously requires clinical functions to deliver relevant outcomes. Therefore, it’s easy to conclude that the whole process of clinical research should be undertaken with a clinical mindset – something that even now plenty of people in the industry would agree with.
My response, as above, is ‘do what you’ve always done, get what you’ve always got’. Approaching the task of recruiting and retaining patients on clinical trials from a clinical perspective has got us to where we are today. Which is the wholly unsatisfactory position where the majority of clinical trials don’t recruit enough patients in a timely fashion, and/or a large number of patients drop out of a trial before completion – both of which circumstances lead to costly delays and revisions to trial protocols and operations.
The main issue would appear to be that a clinical approach is indeed extremely effective at generating and interpreting data. But it isn’t anywhere near as effective when it comes to the elements of engagement, persuasion, and communication that are necessary for convincing people to participate in clinical trials.
I’m not suggesting that all clinicians are the equivalent of Dr Gregory House (from the eponymous TV series), who are only capable of treating diseases, not human beings. But, when you design things from a clinical viewpoint, you are necessarily focused on how best to deliver the desired clinical outcomes.
What this leads to is a process that is designed to extract as much relevant data as possible from the ‘subjects’ of the trial – with no thought given to how to attract these ‘subjects’ and keep them interested in participating. (The use of the word ‘subject’ itself being one that underlines the clinical background of the people developing the process).
Obviously there need to be the relevant clinical requirements and parameters to work within. But I often see trials that have such narrow Inclusion and Exclusion (I/E) criteria for the people who can participate, that they appear to be designed simply to ‘pass the test’, rather than necessarily deliver a useful treatment for the maximum number of people.
Alongside this, there is a clinically-inspired trend for an increasing number of endpoints that have to be measured during the trial – leading to a process that can see trial participants having to spend a lot of time being tested and measured for this data. Which can put people off from consenting in the first place, or lead to ‘trial fatigue’ during participation.
I’d suggest that a clinical approach focuses on test results and has the treatment as the main element. Whereas a marketing approach focuses on appealing to the consumer and has the patient as the main element.
Certainly, the test results and ongoing reporting are vital for the success of any clinical trial and are the basis for why trials are conducted in the first place. But when it comes to patient recruitment and retention, for optimal results the main focus has to be on ensuring that participation in the process is attractive and engaging, rather than off-putting and burdensome.
Adopting the view that trial participants are consumers – essentially emulating the approach of so many other well-funded and successful industries – will help to align the needs of the trial and the likely behaviours of the people taking part.
Fundamentally, consumers have choice and can exercise that choice by going elsewhere. In the case of a clinical trial this choice can be expressed through deciding not to take part, or through dropping out once the trial is underway.
The type of customer service that keeps consumers loyal to their favourite brands – whether that be Apple, Mercedes, Google or whoever – is sadly lacking in the majority of clinical trials. To take those three example brands: Apple makes its users feel like they have access to unique technology and are members of an exclusive club; Mercedes provides a superior product and treats its customers like VIPs; Google provides a service that is easy to understand and places no great burden on the user.
Interestingly, a great advantage that the field of clinical trials has over those organisations is that we are testing our products on the desired end users, at scale, prior to them being introduced into the market. This provides a large amount of data and useful information – of the type that Apple, Mercedes, and Google can only really gain access to once their end products go on sale.
Which highlights another strange phenomenon about the pharma industry. On the commercial side, pharma companies have very well-developed and sophisticated processes for selling their treatments. Two key elements of this are the relationships that pharmaceutical salespeople develop with physicians and HCPs, and the promotion of particular brands to the general public. The activities for which are both very firmly grounded in the principles of sales and marketing.
Yet, when it comes to promoting clinical trials, the industry seems content to view this as a clinical operation, ignoring the marketing capabilities that already exist within its commercial arm. Despite the fact that relationships with HCPs are a core element of this commercial activity – which could presumably be utilized for promoting trial participation to a physician’s patients?
And, if pharma is happy to have a distinction between the manufacturing of treatments and their promotion – with two separate operational centres handling these activities – surely it makes sense to adopt the same approach for clinical trials? Where the essential clinical operations for running the trial are developed and managed separately from the promotional activities that attract people to participate.
Conclusion
All of which leads me to the conclusion that, for best results and outcomes, you should approach patient recruitment and retention as a marketing activity, not a clinical one. (Which is why, even several years after specialising in the field of clinical trials, I’ve kept my LinkedIn profile URL as https://www.linkedin.com/in/rossjacksonmarketing).
If you want a review of your existing patient recruitment and retention activities to see how they might be improved through adopting a more marketing-led mindset, get in touch to arrange a quick intro chat.