3 Things I Wish Sites Understood about Patient Recruitment
It (probably?) doesn't have to be this hard
Sites need to know something about enrolling patients, since they’re the only ones who can actually, you know, do the enrolling.
When we run a centralized recruitment campaign, the effects of that campaign to the sponsor appear as graphs on a dashboard. But to the sites, the effects of that campaign appear as actual breathing humans with a medical condition and a whole lot of questions.
Despite this, a lot of sites don’t really seem to know much at all about patient recruitment campaigns. And as a result, most do not engage meaningfully with the campaign - very few sites ask questions, and even fewer actively request updates or changes. They treat the campaign as a black box. Which is tough, because not only are they living with the consequences of those campaigns, but they are also a big factor in determining how successful those campaigns turn out.
Based on lots of conversations with lots of site folks, here is a small handful of the core things that I really wish they knew. Because knowing them would make them (and me) more successful.
(Note: these are mainly written for private sites conducting clinical trials as a primary business. If you are working at an academic center and your main objective is maximizing your PI’s personal research interests, you’re better off just asking her what she wants you to do.)
1. Enrollment is the goal. Take the assist.
This first one falls into the “do I really even need to say this?” category. But I’m pretty convinced I do.
Enrolled patients represent 100% of your site’s revenue. And by “100%” I mean “ALL”. All of it. No consents, no money.
Money is important for site operations and a source of a lot of site angst. A patient recruitment campaign cannot help with unrealistic FMV numbers in a contract negotiation. It cannot improve your tragicomically slow receivables. BUT it can produce more patients for you, and that will result in more money.
So don’t opt out of the recruitment campaign. Ever. The sponsor is paying for it, and your site benefits from it. Take the money.
And if your response to that is that the time and energy costs for you to deal with the campaign outweigh the financial benefit of the extra enrollments, let’s discuss
2. Pull the levers you can pull
You can’t design the ads or run the campaign (you’re not paying for it). But that doesn’t make you a passive bystander. Patient recruitment companies want you to succeed, because that’s the only way they can succeed. So ask questions, understand the plan, and provide good feedback:
Ask for the funnel. How many referrals does the campaign expect to send you each week? What percentage of those referrals do they expect to be interested and eligible enough to sign a consent? One of the biggest issues we see is the mismatch between a site’s referral volume and its capacity - this can often be fixed with planning if the volume is known in advance.
Change the geotargeting. Many campaigns place ads in a defined radius around your site’s zip code. But one size doesn’t fit all sites and it’s easy to change. So if you know that 95% of your site’s patients come from within 10 miles and the campaign is set to 30, ask for it to be modified so you don’t waste time on unlikely prospects.
Give feedback on the referrals you receive. I get that no one wants to remember another password to another vendor portal to complete another form. But this is important: the referral tracker is a huge source of truly actionable data. Knowing what tactics truly led to enrollment is the only way that the campaign can get better over time. This data is gold, and benefits all of us.
3. Build (and conserve) your patient database
“We’d like to recruit from our own database before joining the central campaign”. This is something we hear so often from sites that it’s easy to forget how truly unhinged it is.
Imagine starting a new job and saying, “before you pay me a salary, I’d like to deplete my savings account first”.
You’re starting a new trial - maybe it will be a good one, maybe not. What better way to find out than to take the free leads that the sponsor has just now prescreened for eligibility in this specific trial? Once you’ve been in the trial for a while, you’ll be in a much better place to assess whether it’s worth it to connect with your own database of patients, or to keep them for another opportunity.
Your patient database is an asset for your site and you should always be looking for ways to build it up.
(Related: every disqualified lead from the central campaign is still someone in your area who has taken the first steps towards being in a trial. They should all be making their way into your database.)
(Also related: if there’s a central campaign running in your area, do not run your own ads to recruit for the same indication. All you are doing is enriching the Zuckerberg family by making both campaigns more expensive.)
In the end
None of the above is intended to suggest that all, or even most, responsibility for enrollment rests on the sites. Sponsors write weird protocols, CROs make weird operational choices, and recruitment vendors run weird campaigns.
But that said, sites that are actively engaged in the enrollment program - asking questions, requesting modifications, and adjusting resources - consistently do much better than sites who treat enrollment programs as a black box outside of their control. If you want your site to succeed, then tapping into an active source of interested participants is the most likely way to get there.