Clinical trials: can technology solve the problem of low recruitment?BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d3662 (Published 14 June 2011) Cite this as: BMJ 2011;342:d3662
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The ongoing debate about poor recruitment to clinical trials and how
to improve recruitment rates has in part focused on technological
solutions to the problem(1). Both Duncan et al(2) and Pick(3) are right to
have provided examples of the benefits of taking a personal approach to
recruiting using dedicated personnel. My own research experience, based on
one of the studies(4) I conducted towards my PhD, highlights the benefits
and importance of recruiting in person.
The observational study I was conducting aimed to identify which
features of websites containing information about a medicine facilitated,
or was a barrier to, people being able to find and understand the
information about the medicine. The eligibility criteria for including
people in the study were they had taken a prescribed or over-the-counter
medicine in the last year and were Internet-literate. (People who were not
would require time to get up-to-speed with using the Internet). I excluded
people under 30 years of age who may have less experience of taking
medicines; and current members of the medical or healthcare professions;
or anyone conducting any form of research.
I recruited people from a busy pharmacy in a large city suburb.
Recruitment took place over seven visits, lasting around three hours each,
between August 2006 and February 2007. In agreement with the pharmacist I
only approached customers after they had dispensed a prescription or made
a purchase. I introduced myself by name, my University I was studying at,
and that I was a PhD student. Then I asked the people if they had a moment
to spare to hear about a study I was running. My reasoning for approaching
people at the point of dispensing their prescription was that they would
be hanging around for the next ten or so minutes until they got their
medication, and so would have time to listen. I specifically asked the
following questions to screen out people who did not meet the inclusion
* If they could use the Internet;
* Their age (if there was doubt that they may be under 30 years of
* Whether they had taken a prescribed or OTC medicine in the last
Those who said yes to all of the above were given a verbal overview
of the study, an information pack, and then invited to take part. A large
number of people were approached in a relatively short period of time,
especially when the pharmacy was busy and those dispensing their scripts
had people with them who were likewise interested in hearing about the
study. Therefore I was unable to keep a record of how many people in total
Many older people were interested in the study but being unable to
use the Internet could not be recruited. Many younger adults, who were
interested and could use the Internet, said they did not have the time to
come to the University to take part in the study. Finding people who met
the tight inclusion criteria and showed an interest in the project was a
lengthy process - on a good day I would have recruited three people.
I remember fondly the time I spent recruiting in the pharmacy. Most
people welcomed being politely approached. Even when they did not meet my
inclusion criteria, they would be happy to talk about wider aspects of my
PhD work (which evaluated written information about medicines), or
healthcare in general. How I wish I had a Dictaphone (and the ethical
approval!) to have recorded some of these rich conversations. Clearly I
could have recruited many more people using this method if I had less
tight eligibility criteria. Researchers who are not seeking to recruit via
the NHS could consider the Pharmacy Practice method of recruitment I have
 Reynolds, T. Clinical trials: can technology solve the problem of low
recruitment? BMJ, 2011. 342: p. d3662
 Duncan, CJA., Dinsmore, J. Hill AVS. Clinical Trials: Not Just
Technology, Dedicated Personnel Improve Recruitment BMJ (Published 22 July
 Pick, AC. Recruiting patients to clinical trials: The Bradford
experience BMJ (Published 15 July 2011)
 Nicolson, DJ., Knapp, P., Gardner, P., Raynor, DK. Combining
concurrent and sequential methods to examine the usability and readability
of websites with information about medicines. Journal of Mixed Methods
Research. 2011 5:25-51.
Competing interests: No competing interests
We agree with Reynolds that here is an expanding role for innovative
technologies in clinical trial recruitment . In our experience, a
dedicated recruitment co-ordinator is also of central importance.
Over ten years of recruiting healthy volunteers for phase I/IIa
vaccine trials in our UK academic centre, we have combined internet-based
recruitment (www.jenner.ac.uk) and social networking sites
(www.facebook.com/pages/Malaria-Vaccine-Trials), with more traditional
However, since appointing a full-time recruitment co-ordinator we
have observed a 427% increase in screening appointments, translating into
a 115% increase in volunteer recruitment (from a mean of 142 per 2-years
from 2000-2008, to 305 per 2-years from 2009-2010; P=0.001, one-sample t
test). This observation contrasts with falling clinical trial recruitment
in the UK reported since the introduction of the EU Clinical Trials
Directive in 2004 . We suggest that effective application of novel
technology to clinical trial recruitment will continue to require
1. Reynolds, T., Clinical trials: can technology solve the problem of
low recruitment? BMJ, 2011. 342: p. d3662.
2. Smyth, R.L., Regulation and governance of clinical research in the
UK. BMJ, 2011. 342: p. d238.
Competing interests: AVSH is a named inventor on vaccine candidates and immunisation approaches under clinical assessment at the Centre for Clinical Vaccinology and Tropical Medicine.
I note with interest Toby Reynolds' article on the problem of low
recruitment to clinical trials, and his finding that only 10% of patients
who are approached by researchers go on to be recruited and randomised.
Our experience at Bradford's Head and Neck Oncology Research Team is
actually quite the opposite. Since 2008 we have been working on a steadily
increasing portfolio of studies, including our own multi-centre trial.
Typically, we find that the vast majority of patients we approach are more
than happy to participate.
We believe that the key to our success is in the personal touch. In
our experience it makes a huge difference if you spend time with patients
carefully explaining the study in question and giving them the opportunity
to ask questions. When we have not been able to do this and had to resort
to just sending patients the study information by post, we find they are
more likely to refuse.
The chance of success is further reinforced by a good patient-
clinician relationship. Many of our patients who have agreed to take part
in research are regularly attending head and neck
clinics, and in the process have built up a rapport with the healthcare
team. They are often only too glad to help in our research work as a way
of giving something back for the treatment they have received.
As Reynolds points out, clinicians' workload can present a
significant barrier to engaging patients in the research process. They are
simply too busy to be able to dedicate the time needed to recruit patients
to trials. This is why teamwork is so crucial. In our team, what has made
the biggest difference has been to recruit 2 research nurses, a research
administrator and a trial coordinator. We are all 100% focused on our
clinical research work and not distracted by other clinical duties. As a
result, our research activity is steadily growing. Of course, all these
people cost money, but funding is available. The National Institute for
Health Research (NIHR) was set-up specifically to facilitate and promote
research in the NHS. Through Comprehensive Local Research Networks, they
manage and allocate funding to meet the support costs of eligible studies.
I hope our experience, encourages and motivates anyone else thinking
of starting out in clinical research that the problem of patient
recruitment is not an insurmountable problem.
Competing interests: No competing interests