Sponsors of clinical research must increasingly focus on improving patient engagement in order to meet many of today’s research challenges. Promising disruptions are already under way that could define new models for patient recruitment and retention.
In a time when drug development success is becoming scarcer and more expensive, the industry is looking everywhere it can for new, innovative approaches to improving health. Meeting recruitment goals is one of the biggest challenges for traditional clinical research. Less than one-third of people who come in for a screening end up completing a clinical trial.1 Thinking in a more patient-centric manner can help is in recruiting patients. A fundamental idea behind patient-centered research is to “amplify the patient’s role in the research process.”2 Employing new ways to engage patients and physicians while increasing their level of knowledge and trust can improve the sponsor’s ability to meet recruitment goals.
One often overlooked factor for study participation and retention is convenience. Raising the level of convenience for both the investigator and participant can eliminate a huge obstacle to non-participation or non-completion. There are many ways to incorporate increased levels of patient and physician convenience into trial design and execution, particularly using Internet-based technologies. For instance, social media can be an effective recruiting tool and an important way to build trust with targeted populations. Disease-specific online communities are becoming more and more prominent for chronic diseases. Matchmaking tools act as mediators that draw together researchers and participants. “Traditional” social media offers a less targeted, but no less effective, way to engage patients and investigators.
In general, the four key determinants of a person’s likelihood to participate in a trial are prior participation in research, existing relationships with researchers, involvement of trusted leaders, and trust in the organization. Keys to recruiting success in social media should keep these determinants in mind, and engage communities in a thoughtful, ethical way while respecting the norms of the community you are targeting.
Participant retention post-recruitment can be improved by strengthening the connections between participants and researchers, and enhancing communication structures to support these relationships.3 Capturing Patient Reported Outcomes electronically (ePRO), through the web or mobile devices, offers a way to interact with the participant in a meaningful way while also capturing critical data. For instance, offering the ePRO user risk scores and health recommendations based on their data, or using gamification techniques to increase protocol adherence, can enhance the traditional ePRO experience by offering direct, immediate value to the user. Enabling a “Bring Your Own Device” (BYOD) strategy can increase convenience for populations who already own their own smartphones or tablets. Of course, the study design and applicable regulatory considerations should drive when and how these techniques are used.
Increased focus on the patient experience is not a phenomenon unique to research, but something that is rapidly permeating healthcare systems. These rapid changes can enhance research engagement. There is enormous potential to capture far more robust data and have better follow up than ever before as widespread infrastructure is put in place for coordinated team-based care, home-based continuous monitoring, and wireless data reporting from medical devices. The (still elusive) promise of using the Electronic Health Record system in research to identify participants and capture clean, accurate trial data is more critical than ever before. As medical practices become more electronic and less paper-driven, investigators and staff should be engaged by providing them trial-specific information at the points in their workflow when they can best make use of it. Conversely, requiring them to go outside the workflows and systems they use in routine practice creates complexity and hassle that can deter research participation. A new level of integration between research and health data systems, based on standards (which exist) and open interfaces (which are coming, as part of Meaningful Use), will be necessary to make good on this potential.
As difficult research questions drive increased complexity in trial designs, many feel that the answer is to use technology in simple, scalable ways to engage more participants in research and capture more data. Dr. Russ Altman, a physician and Stanford professor recently told the New York Times, “There’s a growing sense in the field of informatics that we’ll take lots of data in exchange for perfectly controlled data. You can deal with the noise if the signal is strong enough.”4
References
1. Getz, Ken, The Gift of Participation: A Guide to Making Informed Decisions About Volunteering for a Clinical Trial, 2007, p40.
2. Pignone, Michael, MD, MPH, Challenges to Implementing Patient-Centered Research, Ann Intern Med. 18 September 2012;157(6):450-451
3. Nicholas Anderson, Caleb Bragg, Andrea Hartzler, Kelly Edwards, Participant-centric initiatives: Tools to facilitate engagement in research, Applied & Translational Genomics, Volume 1, 1 December 2012, Pages 25-29, ISSN 2212-0661, 10.1016/j.atg.2012.07.001.