Maximizing The Path To Participation In Clinical Research

It's no secret that delays in recruiting patients for clinical research are one of the primary reasons new drugs are late to market. Each day a drug is delayed can cost a sponsor as much as $10 million; hence, the importance of patient recruitment. Identifying patients to volunteer for clinical research is no easy task. Aside from the obvious challenges (clinical trials are experimental), there are many points at which a potential patient may drop out of the process. Getting all the way through the screening and enrollment process can be very challenging. We call this "The Path to Participation."

As marketers and patient recruitment specialists, it is our responsibility to:

1. Ensure that we identify each step in the process where a potential patient may drop out.

2. Proactively develop solutions that mitigate drops and maximize conversion rates.

So how do you assure that you're getting the maximum conversion rate? From the first point of contact to understanding website traffic, the opt-in process, and ending with randomization into the study, it's all about analytics and tracking!



To demonstrate the path to participation and how analytics can be used to improve conversion rates, let's take a look at John's path.

John is 53 years old, married with two kids, lives and works in the suburbs, and has Type II Diabetes. He's tried several treatment options, including diet and exercise, but his diabetes is not in control.

While watching TV one morning, John saw an ad for a clinical trial that connected with him. A toll-free number and URL were provided as means to learn more. He made a mental note of the URL. By the time he got to work he forgot the exact URL. He remembered enough to find the website on Google and clicked on the link.

The Top of the Funnel -- Source-Tracking Codes

Understanding inquiries at the top of the funnel is critical. Many recruitment campaigns incorporate multiple outreach tactics to cast both wide and small (but targeted) nets. Tagging each inquiry with a source allows you to shift dollars around and improve cost per inquiry. It also enables deeper analysis further down the funnel and a means to evaluate a true return on investment. However, capturing source can be tricky. In John's case, the keyword on Google would be tagged with the source of inquiry; yet, the real source was TV. So consider adding a "how did you hear" question on the website pre-screener so that leads such as John's can be tagged with a secondary code for TV.

John visited the website for six minutes and ultimately closed the browser. Later that day he returned to the website and completed the online screener. Unfortunately, the closest participating physician was downtown, a 30-minute commute. Even though he qualified, he was still deliberating on whether or not this was right for him.

Page Views and Bounce Rates -- The User Web Experience

What made John close his browser and on what page did he exit? How much time did John spend on each page? Was he engaged? Was the wording in the online pre-screener confusing? Exit rates, bounce rates, page views and time spent on each page are just a few standard data points that help paint a picture of the user experience. Those insights can be used to make changes to immediately increase the conversion of website visitors to pre-qualified subjects. For example, let's say we learned that John exited on the page that explains the online qualification process. The copy reads that the online screening will take approximately 12-16 minutes. Is this number accurate? Is the time a deterrent? Or is it effectively managing patient expectations? Subtle changes like removing this mention of time can make a huge impact on the bottom line. In fact, we've seen as much as 10% improvement in conversions through minor changes like this.

Two days after his pre-qualification, John received a call from Nancy, the study coordinator at the physician's office. Nancy asked John several detailed questions about his diabetes, medication and health history to further qualify him. John then asked Nancy about the number of visits required, the clinical trial process, and study procedures. At the end of the conversation John scheduled an appointment. Unfortunately, Nancy didn't have any opening for three weeks -- a lot of time for John to potentially reconsider his decision. After carefully weighing his options and talking with his endocrinologist and family, John decided to attend his appointment. He met the physician, qualified for the study and enrolled.

Closing the Deal -- The Study Coordinator

Study coordinators are the front lines of a research site, and they greatly influence the success or failure of your clinical trial. They are the patient's first point of contact -- a warm, reassuring presence goes a long way in helping the patient decide to participate. Coordinators are typically not trained in sales or customer service, yet this is a critical role they play in maximizing conversion rates of inquiries. They need to respond promptly to patient inquiries and effectively address their questions and concerns.

It is important to train study coordinators upfront on your patient recruitment program and ensure they understand the outreach efforts, the pre-screening process and reporting expectations. Keep in touch with them regularly, support their efforts and solicit their feedback. They can identify barriers to participation and help brainstorm ways to address these challenges. Make sure that they're following up with inquiries in a timely manner, have open appointments for scheduling, and are reporting on the status of the inquiries. Supporting a study coordinator in resolving inquiries can significantly increase the number of inquiries that wind up enrolling in the study.

From the moment that John was exposed to the advertisement to the date of study enrollment, there were many points along the path to participation that could have easily led to his disinterest in the study. Understanding the path and its potential barriers and obstacles is absolutely imperative to ensuring success. And it's through robust and detailed analytics and tracking that the recruitment of patients becomes as accurate, scientific, and carefully planned as the clinical trials that they support.

2 comments about "Maximizing The Path To Participation In Clinical Research ".
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  1. Linda Gonzalez from ViVA Partnership, March 22, 2011 at 2:41 p.m.

    Neil: Great article and very valuable information. I really like the way you laid out the challenges and provided solutions. Clinical research companies are sure to find this article interesting and highly applicable to their business.

    Having worked for both pharmaceutical companies as well as a clinical research company, I understand the challenge of recruitment AND retention. My company's area of expertise is in Hispanic marketing and there is a clear difference in the Hispanic path and barriers when compared to the general market, especially when it comes to clinical trials. For example, though the primary contact may be similar to the non-Hispanic participant (i.e.TV) , his secondary and subsequent contacts are much less likely to be via online.

    As the U.S. becomes more multicultural, developing various Multicultural Paths to Participation would help enroll and keep volunteers participating throughout the trial. Have you considered that?

  2. Paula Lynn from Who Else Unlimited, April 17, 2011 at 8:43 p.m.

    The more people lose their healthcare, the more enticing a clinical trial becomes. 50% chance a medication will work is better than 0% no medication chance. PS: A Z pac out of the US costs $14 to the consumer.

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