Physician Referrals For Clinical Trials: The Holy Grail Or A Reality?
When it comes to recruiting patients for clinical trials, physicians typically rely on two sources:
- Patients within their practice
- Patients who respond to advertisements
There is, however, a third source that could potentially provide a wealth of patients for clinical trials—physician referrals. These are referrals from doctors not involved with the clinical trial but who may have eligible patients in their practice. Referring physicians are often considered the ‘holy grail’ of patient recruitment. They can provide highly-qualified patients, saving sites time on pre-screening efforts and reducing out-of-pocket costs. These patients are often more motivated to participate because their doctor recommended it.
However, efforts to generate physician referrals have long been stagnant and unsuccessful in clinical development for a variety of reasons:
- There is little incentive for physicians to refer patients (it is unethical to compensate physicians for referrals, either monetarily or otherwise).
- Physicians don’t want to lose their patients to other physicians, since this can affect their bottom line.
These challenges are real and substantial, but having a disciplined and rigorous strategy can help you overcome them. As clinical research professionals, too often we focus on tactics, which can lead to dead ends on our quest.
So how do you begin to develop a strategy for physician referrals? At my agency, we have a process called Uniting Patients to Hope. Like most strategic development processes, ours is fairly simple. It sets a strategically-sound foundation for your entire campaign, which will ensure you are rewarded with excellent campaign results.
Below are a few of the key steps in the process:
Assess the Challenge
Set goals that are specific and modest, such as two referrals per site across 20 sites in six months, or one patient per site per month.
How do you define the referring physicians? Are they internists or specialists? What are their attitudes towards clinical research? What interests them? Are there plenty of treatment options available to their patients (i.e., diabetes) or fewer options (i.e., a rare disease)?
The obvious action here is to refer patients to a trial, but dig deeper. What specifically do we want physicians to do? Review the study with their patients? Place collateral in their office? Train their staff? And we want them to do this instead of what other action? Instead of treating the patient themselves? Instead of referring them to a specialist? Instead of ignoring the study altogether?
Some key barriers have already been identified, including lack of incentive and fear of losing their patients. But what’s the primary barrier specific to your trial that will prevent physicians from referring patients? Is it the placebo arm? Is it the amount of data available on the compound? Your communications must directly address the key barriers identified.
In the absence of direct compensation, what motivates physician referrals? Is the investigational medication innovative—something a physician could not offer patients otherwise? Does the trial offer medical treatment when patients cannot afford to pay themselves? You need to figure out what will make physicians feel good about referring a patient.
When, where and how will the physician be most receptive to your message? Communications should be delivered in a way that fits into the natural course of their day. For example, we know that physicians over-index in smart phone, lap top and tablet technology consumption—take advantage of this.
It’s also important to define when during a patient’s course of treatment they are most eligible to participate in a clinical trial. When they are first diagnosed? When a course of treatment has failed? How do you reach and motivate physicians at this critical point?
After gathering the above information, what is the key insight for the strategy? What is the central idea that is original, inspiring and true to these physicians? Insights need not be earth-shattering ideas. Some of the best are surprisingly simple. For example, if physicians knew your trial involved an approved first-line cancer medication in addition to an investigational one, they would be more inclined to refer patients.
Once a strategy has been thoroughly defined, now you can focus on tactics and execution. Make sure you carefully measure each tactic against the strategy. Sometimes it’s tempting to go off-strategy because of “a great idea.” These are what I like to call “marketing sirens”—a sexy idea that causes you to abandon your strategy. Continue to refine the strategy, messaging and executions as you gain momentum. With a well-developed strategy and on-target tactics, you are likely to astound your clinical development team as you open up yet another channel for patient recruitment.