Reach subjects through targeted recruiting
Reach subjects through targeted recruiting
Expert develops recruitment model
There’s a lot of focus on informed consent and compliance with human subject protection regulations. In the clinical trial process, that comes later. What comes first is getting people to volunteer for the trial.
According to Diana Anderson, PhD, president and CEO of D. Anderson & Co., a firm specializing in patient recruitment and retention, in the United States less than 6% of those eligible to participate in a clinical trial do.
With 80,000-plus clinical trials, the need for participants continues to swell, says Anderson, who wrote the book, The Guide to Patient Recruitment and Retention. She was a presenter at the Association of Clinical Research Professionals annual conference held April 2-6 in Orlando.
To get a better understanding of who volunteers and why, Anderson’s company surveyed 200 people from their database of participants and asked them questions about what motivated them to participate in a clinical trial.
Altruism not always at the core
In her ACRP presentation, Anderson said historically people volunteer for clinical trials for the following reasons1:
- they are not adequately treated with current therapy
- to seek new treatments
- to help future generations
- to get study-related treatment at no cost
- to comply with a physician’s request
- to seek attention from physicians and staff
In Anderson’s sampling, the reasons given were similar but she found that the way the questions were asked had an impact on responses. For example, when respondents were asked to provide an answer to the open-ended question: "What motivates you to participate in a clinical trial?" 45% answered, "To advance medicine/science and help others."
However, when those same respondents were asked to chose among a list of answers, only 5% chose "Advance science and help future generations." The answer chosen most frequently — by 50% of respondents — was "To try new medicine to see if it works better for me." Only 20% provided that as an answer to the open-ended question.
Attitudinal segments
In an effort to understand attitudes and needs, Anderson developed the Attitudinal Segmentation Model. The model hypothesizes that six primary attitudinal segments exist and have an impact on recruitment efforts. By knowing to which segment a targeted population belongs, recruiters can tailor their approach to be more effective at reaching and converting potentials to subjects.
The segments are "physician followers," "scared and seeking," "nothing to lose," "latest, greatest seekers," "financially frightened," and "content and accepting."
Physician followers. According to Anderson, this group is slightly less educated and highly influenced by physician recommendation or endorsement. "Fifty percent of the database indicated that the physician was a key component in the subject’s decision-making process," Anderson says.
This segment relies on relationships, so those trying to reach physicians followers may want to use resources to educate physicians about clinical research.
"Only about 1% of physicians conduct clinical research," Anderson says. She suggests community-based outreach, such as physician dinners or seminars on how to become a successful investigator.
Scared and seeking. This group is newly diagnosed with long-term disabling or life-threatening disease, Anderson says. They are primarily women, and are motivated to drive farther and wait longer for treatment options that might improve their condition.
In order to reach this group, recruiters may want to think about developing relationships with diagnostic centers.
Nothing to lose. This group is in the more advanced stages of disease. Anderson says they typically have exhausted their treatment options and are hoping for an advancement or looking to to help others.
With this group, the emphasis on helping future generations would likely be effective. "Many may be thinking, This may not help me but I don’t want my family or friends to go through this,’" she says.
Latest, greatest seekers. This group is made up of people who are advocates for their own health. They typically are well educated and affluent, and generally are women or those under the influence of a woman, Anderson says.
Ads in prevention-based publications could be effective in reaching this group. She points out that advertisements would need IRB approval.
Financially frightened. This group is highly motivated by offers of free health care. They typically are uninsured or underinsured. "Surprisingly, money is not a motivator in this group. It’s the opportunity for treatment that is the motivator," Anderson says. She suggests partnering with indigent clinics and public health centers.
Content and accepting. This group is risk averse, Anderson says. They are satisfied with their current medical treatment. In spite of the potential for benefiting the greater good because they don’t see participation as a gain for them, they likely won’t volunteer.
"They are without question the most difficult group to recruit," Anderson says. "Because we don’t know much about them, it’s an area in which we need to conduct a lot more research."
Reference
- Spilker B, Cramer J. Patient Recruitment in Clinical Trials. New York City: Raven Press; 1992.
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