The Trust Deficit: Is An Overlooked Literacy Gap Stalling Clinical Trial Enrollment?

By Jeremy Westfall and Joan Severson

For decades, low clinical trial enrollment has been framed as a logistical, financial, or demographic issue. Yet this view misses the deeper root cause: a persistent gap in patient understanding that undermines trust from the outset.

While the industry invests heavily in linguistic translation — for example, converting materials from English to Spanish — it continues to overlook literacy-level translation. Protocols, eligibility criteria, and consent forms are often written at an academic level far beyond the comprehension of most patients, creating barriers for the very populations trials aim to engage.

This article examines that critical disconnect and explores how emerging purpose-built AI platforms, unlike raw generative tools, can integrate seamlessly into compliant, validated, and role-specific workflows to translate complex medical language into plain, accessible communication. Though not a cure-all for the broader issue of patient trust, these technologies represent a meaningful step toward improving comprehension, enabling site staff to communicate with greater clarity and consistency, and ultimately strengthening the ethical foundation of patient engagement in clinical research.