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The Past, Present, and Future
of Clinical Research Recruitment
For thousands of years, humans moved their knowledge of medicine forward through informal,
anecdotal, experimental, sometimes very dangerous methods. It was not until the mid-20th century
that organized clinical research trials became a central element of medical progress, and since that
time, millions of people around the world have benefitted from the careful, safe study and approval
of medications and other treatment methods for negative health conditions of all types.
Finding people who are willing to participate in a clinical trial has always been a starting point of any
research project, and the way organizers find volunteers has evolved along with the clinical research
process itself. From simple word-of-mouth recommendation to the use of massive computer
databases filled with detailed patient data, here is a brief overview of the past 100 years in clinical
research recruitment, a look at what practices are prominent at present, and what changes we can
look forward to in the coming years.
1870-1940: Reaching the Community
As a step up from word-of-mouth recruitment, any sizable gathering of
people in the community was an opportunity for clinical trial organizers
to reach out to potential volunteers. Rotary clubs and other groups
often heard appeals from doctors to spread the word about research
trial opportunities. When finances allowed, organizers also placed
advertisements in the most prominent mass marketing tool available at
the time: the newspapers.
1940-1990: Mass Media
As doctors and educational institutions first
began conducting and recording tests of
unproven treatments, they spread the word
and collected volunteers in the simplest way
possible. Doctors invited their own patients
to participate and used what records they
had to make contact with past patients
who might also be willing to volunteer. This
approach quickly outlived its potential,
though, as trial organizers ran out of contacts
and it became necessary to draw volunteers
from the wider public.
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The success of the clinical trial model resulted in a proliferation of trials
being conducted across the United States. During this period, individual
sites dedicated to conducting research trials became the norm, rather
than using doctors’ facilities or space at universities. With the rise of radio
as an exciting new way to speak to large populations, these sites began
placing ads with the radio stations that reached their target areas. Later in
this period, television also became a recruitment marketing tool, but only
for those sites and organizations that could afford the high costs of video
production and television airtime.
The Postal Service was another obvious tool for clinical trial organizers
looking to reach potential volunteers who lived close enough to the trial
site to participate. The ZIP code system helped recruiters send trial
notifications to all the residents in a given radius of their site. While early
direct mail efforts simply blanketed the community with volunteer requests
in an “every-door” approach, it would not be long before the computer
age made it possible to gather enough information to target the most likely
qualified candidates within the radius and spend marketing dollars on
reaching only those candidates.
Around the turn of the century, the explosion of digital technology changed clinical trial recruitment drastically, just as
it did so many other areas of the medical field. Some long-established marketing methods became more focused and
effective, thanks to improved information gathering and storage, and the Internet created a number of brand new marketing
opportunities. A major theme in research trial marketing during the current era is discovering how to best use digital
communication to reach new, qualified volunteers.
Direct Mail Becomes More Directed
Despite the predictions of some people
that the U.S. Postal Service would become
obsolete as digital communication took
over, the last two decades have seen
printed marketing materials move into a
different, but still important, role. Marketers
recognize that direct mail still holds some
meaningful advantages over email, its most
direct competitor. Each piece of mail, for
instance, generally receives some amount
of attention from the recipient, while emails
frequently get overlooked or automatically
consigned to a junk folder.
Technology has also made direct mail much
more effective for clinical trial marketing
in terms of audience targeting ability.
Through voluntary surveys administered in
a variety of contexts, people can indicate
their willingness to receive clinical trial
notifications and provide information about
their own health conditions. Collecting
this valuable information from millions
of respondents and storing it securely is
now feasible, allowing patient recruitment
agencies to offer individual research sites
filtered, sorted mailing lists focused on their
geographical location. Such a mailing list
gives a site the ability to send marketing
materials only to local addressees who
have indicated an interest and probable
qualification for the clinical trial in question.
Internet Marketing Strategies
An informative, user-friendly, and preferably
interactive website has become a basic need
for a clinical research site that plans to reach
volunteers online. A high quality website can
provide general educational content to the
public about the clinical research process,
combatting false preconceptions about
its safety and its demands on volunteers’
lives. It can also provide trial-specific
information to respondents through the use
of personal URLs and make it easy for those
respondents to pass on sensitive personal
and medical information in a secure context.
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In addition to a website, there are three leading online marketing methods
that have attracted the attention of clinical research recruitment experts,
with varying levels of success so far: social media activity, email, and payper-click advertising (usually through Google AdWords).
While the low-cost, wide-reaching nature of sites like Facebook,
Google+, and Twitter seemed to hold great promise for targeted clinical
trial marketing, the need for IRB approval of marketing messages has
prevented social media marketing from becoming a streamlined, easily
executed strategy. Research organizations have found far more success
using social media for general promotional purposes—acquainting the
community with the basics about clinical research, providing valuable
health information as a service to the public, and building a positive
image in preparation for direct recruitment efforts. A recipient of a
recruitment mailer or doctor recommendation about a clinical trial is more
likely to respond if he already has some level of personal knowledge
about the organization.
Soon after email became a mainstream form of communication, users
became overwhelmed by huge numbers of marketing emails filling their
inboxes as retailers rushed to capitalize on the low-cost alternative to
printed materials. Today, most email providers offer junk folders that
automatically reroute most marketing messages away from the main
inbox. The negative effect of this system for clinical trial recruitment is
that nearly any trial marketing email, due to its wording, is in danger
of being flagged as junk and kept out of view of the recipient. For this
reason, emailing new contacts with recruitment messages rarely yields
meaningful response rates.
Email is quite useful, however, as a means of keeping in touch with past
trial volunteers and potential participants who have volunteered to receive
email messages. By specifically opting in to receive messages, these
individuals ensure that the research organization’s emails will reach them.
Clinical research sites do well to build and update their email contact
lists, as those contacts are often willing to volunteer themselves and/or
encourage acquaintances to volunteer for later research trials.
Pay-Per-Click (Google AdWords)
Clinical research organizations are just beginning to realize the great
potential that pay-per-click advertising holds for trial marketing. This
strategy is low-cost and has the unique benefit of reaching only individuals
who are actively searching for keyword phrases related to the indication of
the trial being marketed. As recruitment agencies perfect this technique,
it promises to become one of the most important Internet marketing
practices in the toolbox of research organizations.
Two important trends seem poised to drive the changes in clinical trial recruitment strategies in the coming years: increased
audience targeting ability due to more detailed data gathering and storage, as well as the continued shift from offline to
online marketing in all sectors.
It seems clear that gathering detailed information about potential
volunteers will continue to become easier and less expensive, thanks to
technology. Storing more names, addresses, indications, and details with
increased accuracy and updating ability will give research sites and CROs
greater power to target more people that are interested and qualified to
participate in clinical trials.
The Digital Shift
Although there is a current distinction between the younger, tech-savvy
generations and older generations that are more comfortable with
traditional communication, that distinction will become less clear and
probably eventually disappear as more people grow up using computers,
smartphones, and other mobile devices on a daily basis. Reaching potential
volunteers online will become essential, and live interactive options such as
text messaging and online chat will become core methods for answering
respondents’ questions and enrolling them in clinical trials.
Getting Clinical Trial Recruitment Right—Today and Tomorrow
The ever-changing landscape of communication in our culture is a real challenge for clinical
research organizations that are interested in reaching as many qualified trial candidates as
possible. The lesson of history is that these organizations cannot allow themselves to become
locked into a particular set of marketing strategies as technology trends change around them.
Just as the early trial organizers had to move on from addressing rotary club meetings to placing
radio ads, today’s trial recruiters must constantly look ahead, anticipating what marketing
approaches will become more important in the days and years to come.
Clinical List America is a full-service clinical trial recruitment agency, offering
help for individual research sites and CROs with the full range of recruitment,
promotion, and branding activities.
Clinical Leader, “Using Social And Digital Media To Increase Patient Recruitment And Retention,” http://www.clinicalleader.com/doc/usingsocial-and-digital-media-to-increase-patient-recruitment-and-retention-0001?sectionCode=Editorial&templateCode=Single&user=3133386&s
ISR Reports, Whitepaper: “The Expanding Web of Clinical Trial Patient Recruitment,” Industry Standard Research, 2014.
National Center for Biotechnology Information, “Evolution of Clinical Research: A History Before and Beyond James Lind,” http://www.ncbi.nlm.nih.gov/
pmc/articles/PMC3149409/ (accessed 10/22/2015)
National Institute on Aging, “Using marketing principles to improve clinical trial recruitment,” https://www.nia.nih.gov/alzheimers/features/usingmarketing-principles-improve-clinical-trial-recruitment (accessed 10/22/2015)
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