We're Looking At Patient Recruitment All Wrong

By Dan Schell, Chief Editor, Clinical Leader

I’m not a fan of patient-centricity.
Don’t get me wrong, the concept is solid, it’s the use of the term that bothers me. For years, companies have touted their patient-centric products, services, policies, philosophies … whatever. In many instances, it’s hard to quantify what any of that means, and consequently, “patient-centric” has become ubiquitous marketing lingo. I mean, what life sciences company doesn’t want to say it is focused on the patient?
I’ve made this rant before, I know, and I apologize, because I recognize there are actual examples of real patient-centricity out there. I was reminded of that recently when I interviewed Leanne Woehlke, a 30-year veteran of the clinical research industry who hosts her own podcast called Clinical Research Coach.
ARE WE MEETING TRIAL PARTICIPANTS’ 6 BASIC NEEDS?
Woehlke reached out to me because she wanted to talk about “a unique perspective which is often missed in traditional patient recruitment campaigns.” As we began chatting, I quickly understood why her title on LinkedIn says:
Patient Obsessed! Reimagining the way pharma interacts with patients — Passionate about improving the patient experience and increasing access to clinical trials.
She explained that she learned a lot about the “patient experience” when her husband was going through cancer treatments years ago. She was able to see firsthand some of the simple, little things that could be improved upon not only for how we treat trial participants but patients in general.
“Unfortunately, clinical people are not great marketers,” she says. “They put up a website that says something like ‘This trial is for a double blind, placebo-controlled study of some compound that is hard to pronounce for a very technical explanation of this medical condition’ and people opt out because they don’t understand the terms, or they don’t know if it’s even right for them.”
As a trainer for Tony Robbins, Woehlke had learned about this theory of six human needs, which posits that the reason people do anything is to meet one of these six human needs (see below). She emphasized that meeting these needs can improve patient recruitment and retention.
1. Certainty: Patients have a need to know what will happen during a clinical trial. Thus, we need to provide them with a sense of certainty and security.
2. Uncertainty/variety: It is helpful to incorporate elements of surprise and delight in the patient experience, such as acknowledging them with a token of appreciation on a milestone visit, or surprising them with a call or a card on their birthday. These unexpected gestures can go a long way in helping to improve participant retention.
3. Significance: Trial participants deserve to feel important and valued. As such, look at small things like how long they are kept in the waiting room or whether or not they are acknowledged when they arrive. Are you treating them like a VIP?
4. Love and Connection: They want to feel like they’re part of something, so make them feel like they belong. Thank them at multiple stages of their experience — arrival, during participation, and departure. Make sure they understand that they matter and are appreciated.
5-6 Growth & Contribution: Being in the trial, the person needs to feel like they are growing as a person but also contributing to something larger than themselves. People are only altruistic to a point.
THE COMMODIFICATION MODEL IS OUTDATED
Throughout our conversation, I kept thinking about how these patient-centered tactics would be great for keeping a person in a trial, but I still was confused as to how they could help with recruitment. Sure, making marketing materials simpler to understand does help, and so does avoiding sending a potential trial candidate to clincialtrials.gov for more info on a trial (that’s a sure way to get someone frustrated). But a lot of it comes down to staffing. Woehlke says approximately 78% of sites don’t have clear recruitment plans, and most can’t get back to a potential trial participant within three days. “I had to laugh; I once saw a 200-page document that was basically a guide for study coordinators on how to be social media managers so that they could run Facebook and Instagram ads,” recalls Woehlke. “At best, they’re going to be poor at it, because it’s not their forte. Instead, we need to figure out ways to get coordinators back to doing what they love and what we hired them for initially — being with patients and giving care.”
Every tech vendor out there thinks they have the solution to this age-old problem, and many of them are making headway. But we all know there is no silver bullet, and we also know that AI is likely going to be a part of whatever solution we come up with. You already are seeing examples of how AI is being used to mine data, looking at unstructured medical records and then comparing that data with clinicaltrials.gov data to find matches for a trial. It is also being used in prescreening to weed out potential patients before they even get to the site level.
“We’ve got to stop looking at a patient as a commodity and more as a person,” Woehlke says. “So, when we talk about patient-centricity at this stage, it’s more like whole-person recruitment. Are they a mom or a dad? Are they a sister or brother? What else is going on in their life, and how can we help meet those needs, if at all? We throw debit cards at people all the time as if that’s going to solve their problems. But if I’m a working person, maybe what I need to be able to participate in your trial is to know you’re going to get me in on time, to know that I will have internet access while I’m there so I can continue to do my work. Are we asking people this? Probably not.”
One stat that I had stuck in my head during my conversation with Woehlke was that around 30% of trial participants drop out of a trial after enrollment. There are lots of reasons why this happens, but I couldn’t help but wonder how much lower that number would get if we implemented even a portion of these patient-centric approaches. The trickle-down effect of that includes site coordinators who are happier in their jobs, focusing more on the needs of the trial participants.
So, I’m changing my stance on patient-centricity — not every use of the term is BS.