Why Feasibility Still Feels Broken
By Dan Schell, Chief Editor, Clinical Leader
While scarfing down my breakfast on the last morning of the Research Revolution conference, Dresden Whitehead, joined me at my table in the room where we awaited the day’s keynote. As I shoveled in more bacon than I should have eaten, she told me she was the Site Intelligence Manager for Avacare Clinical Research Network and focused on helping sites with the feasibility process. In fact, she was speaking on a panel later in the day called “Reimagining Site Feasibility: Data-Driven Partnerships Between Sites and Sponsors.” Our brief chat stuck with me, and after we both got home, we set up time for an interview. What she walked me through reminded me of another feasibility discussion I couldn’t shake — our 2024 Clinical Leader Live, How Can We Improve Clinical Trial Feasibility Processes?. Different venues, different people, same frustrations. And unfortunately, the same problems.
The Repetition Crisis
One of Dresden’s biggest points was almost comically simple: Sponsors and CROs keep asking sites the same questions over and over again, even when they’ve already worked together. She described 50-question feasibility forms filled with basics like freezer capacity and refrigerator access; you know, questions every functioning research site has answered dozens of times. Worse yet, she said the very same sponsor might send those same questions for each new opportunity. “If we’ve run three or four studies for you, why are you still treating us like strangers?” she asked.
It’s almost the exact conversation the Clinical Leader Live panelists had. They agreed the industry’s reliance on bloated questionnaires wastes time and pushes feasibility in the wrong direction. One panelist noted that freezer status and regulatory contact info should be handled during the PSV, not during initial feasibility. The real focus, they argued, should be on whether a site can access the right patient population and enroll at a rate that makes sense for that protocol.
Between both discussions, the message was clear: Feasibility is clogged with clutter, and everyone knows it.
Everyone Wants New PIs … Until Selection Time
Dresden has a soft spot for new investigators who want to get into clinical research. She does what many networks try to do; pair experienced PIs with newer ones to build a more balanced and sustainable bench. But when feasibility responses go back to the sponsor, the new PIs rarely make the cut. Despite public commitments to diversity, site expansion, and community engagement, almost everyone still chooses the same veteran investigators with a proven track record. “They say they want the new ones, but their decisions don’t reflect that,” she told me.
The CLL reinforced this tension. One panelist admitted that when sponsors rely heavily on past performance data, brand-new sites never show up in the rankings at all, even if those sites sit in communities the industry desperately needs to reach. It’s hard to build a more equitable research ecosystem when the tools themselves keep steering everyone back to the same handful of high-performing sites.
Clarity Beats Guesswork
Another recurring issue was the lack of transparency in what sponsors actually want. Dresden said site networks often receive vague feasibility requests with little more than, “What do you have?” Without a clear site profile — required capabilities, PI experience expectations, population needs — her team is forced to guess. And when they guess wrong, weeks get wasted.
This lines up nicely with what we heard in the Clinical Leader Live: projections are unreliable because sponsors often reach out before the protocol is finalized. Panelists noted it’s impossible for a site to provide meaningful estimates when key eligibility criteria or procedures are still in flux. If sponsors want better forecasts, they need to provide better inputs.
In both discussions, the solution was pretty simple. Sponsors should come to sites with a clear site profile and realistic expectations. And if they don’t, sites shouldn’t hesitate to ask for one.
The Race Against the Clock
If there was a single theme Dresden returned to more than any other, it was speed. Feasibility has become a game of fast turnarounds, fast responses, and fast data. She explained that coordinators already feel underwater, and feasibility forms only add to the strain. Her role often involves coaching teams on the importance of thorough documentation (even when they’re exhausted), because the data they enter today is what determines whether their site will be selected tomorrow.
The CLL panel echoed the same pressure. One panelist noted that once a CRO is hired, timelines are condensed and every day costs money. Feasibility requests often go out before sponsors are truly ready, creating a chain reaction of rushed responses and unreliable projections. It’s no wonder sites feel like they’re sprinting through a process that should be thoughtful and deliberate.
The Promise — And Skepticism — Of Data
Ironically, while the industry agonizes over inaccurate projections, sites finally have the ability to produce real, data-backed feasibility metrics. Dresden walked me through how her sites track EMR response rates, screening ratios, enrollment percentages, and retention rates with far more precision than even a few years ago. “I have the data to show exactly what we can do,” she said. “But sponsors still cut those numbers in half because they don’t believe us.”
Monica Jane from J&J said something similar during the CLL: Predictive models and EHR data can dramatically improve accuracy, but only if everyone trusts the output. The industry can’t claim to be data-driven while ignoring the data sites actually provide.
Despite this, Dresden sees progress. The tools are getting better, even if access to them is uneven. And when sites pair accurate enrollment funnel metrics with strong documentation, they put themselves in the best possible position to stand out. Now all we have to do is get everyone to stop inflating and deflating (do we deflate numbers? Hmmm…) their numbers.
Easy, right?
Right