Applied Clinical Trials
Survey uncovers deeper learnings of patient perceptions of clinical research and the motivations to participate.
For the past several years, there has been increasing discussion of what patient centricity means in clinical trials. The premise is that better study designs, approaches, and services that are focused on the needs and preferences of patients can improve clinical research participation and, therefore, help advance the development of medicine and medical devices. Yet, despite the focus on this concept, the general consensus is that much work remains to realize its potential.
Previous research by the Center for Information and Study on Clinical Research Participation (CISCRP) has shown that patients typically partake in clinical research for both altruistic reasons and with hopes of benefiting their personal health. Other research has also begun to identify what patients want when participating in a trial.
While this is valuable research, the industry hasn’t addressed some important questions: Do patient needs and preferences vary by condition and other patient demographics? Could gaining a better understanding of patients’ lives and the factors that affect their decision to participate in the trial help to create a more attractive patient experience? Is it time to think about making the studies fit the patients’ needs better? What would it mean to move away from viewing patients as subjects in medical research, and engaging them as the stakeholders they are?
Overview of survey and methods
During the summer of 2018, Antidote Technologies and SCORR Marketing partnered on a survey to gain a deeper understanding of patient perceptions of clinical trials and their motivations to participate. The survey also was designed to identify differences related to condition, household income, education, ethnicity, and gender.
Survey participants were recruited to participate by Antidote’s partners: American Kidney Fund, Allergy & Asthma Network, Healthline, JDRF, Lung Cancer Alliance, Lupus Research Alliance, Melanoma Research Alliance, and Multiple Sclerosis Association of America. Each partner organization distributed the survey to its membership through a combination of emails, website posts, and social media posts. Some worked with other partner organizations in their disease area to generate responses from caregivers and patients.
About the sample
Of the nearly 4,000 survey respondents, the majority (89%) identified as a patient. Twenty-seven percent of respondents have multiple sclerosis (MS), 15% have asthma and/or allergies, 13% have kidney disease, 12% have melanoma, 12% have type 1 diabetes, 10% have lupus, 6% have lung cancer, and 5% have gastrointestinal disease. Twenty-six percent of respondents had participated in a clinical trial at the time of data collection.
Most survey respondents (84%) had at least some college or a college degree, and more than half (53%) reported an annual household income of less than $75,000. The sample skewed older (74% of respondents were over the age of 45), white (90% of respondents), and female (80%).
Patient motivators for participating in medical research
Providing prospective patients with the right information to make a decision starts with understanding what drives patients to join a trial in the first place (see Table 1).
Click to enlarge.
Of the 26% of the respondents who had previously joined a clinical trial:
All survey participants rated the importance of 16 potential motivators to take part in a trial. Each motivator was placed in one of the following categories: safety concerns, health benefits, logistical concerns, institutional support, and financial benefits. The percentage of the survey population rating the type of consideration as very important and the average ordinal ranking (where a lower number indicates a higher ranking; see Table 2).
When we asked respondents about the possible motivators to participate in a clinical trial, unsurprisingly, safety topped the list of priorities. Seventy-three percent said it was very important that the research not interfere with their current treatment or make their conditions worse. This was the chief safety concern expressed. Of the eight condition categories included in the survey, patients with kidney disease assigned the highest importance to the idea that the clinical trial should do no harm.
Having someone available to answer questions throughout the study (66%) and their doctor’s support for their decision to participate (50%) were important to respondents as well. Lung cancer and melanoma patients were most likely to deem it “very important” that their doctor supports their decision to join a clinical trial. Women are more likely to value the importance of having their questions answered throughout the study.
The potential to benefit their personal health was also important to the respondents. About two-thirds (67%) of respondents identified this statement as the top health benefit: “The trial provides me with a drug, therapy, treatment, or medical device that potentially could extend or improve the quality of my life.”
Logistics play a role in decision-making as well. Respondents felt it very important that they could complete the entire trial. More than half (59%) of the respondents deemed this as very important and the top logistical concern. Patients with kidney disease, MS, or allergy/asthma place a higher priority on logistical factors than patients with other conditions. Overall, only a minority of respondents said it is very important that a trial doesn’t take time away from their obligations and, similarly, only a minority considered it very important to have clinical researchers make home visits.
Financial benefits, while very important to some, are generally viewed as less important than other considerations. Oncology and type 1 diabetes patients were the least inclined to be concerned with financial considerations. Less than half (46%) of the respondents said being compensated to participate would be a motivator; however, younger respondents or those with lower household incomes were much more inclined to believe compensation would be a motivator to participate.
Patients as partners
A key element of patient centricity may relate to the industry’s ability to truly embrace patients as partners. And this effort revolves around medical professionals:
However, despite the influential role medical professionals have, only one-third of these respondents have ever talked about research with their doctor.
Similarly, having the necessary information to make well-informed decisions about participation is a key theme that runs through many of the patient responses:
The results of the survey raise important points about clinical research:
More important than these findings is the confirmation that there is not a one-size-fits-all solution for engaging individuals in medical research. Rather, it is important to consider the particular obstacles facing patients when they are making decisions about whether or not to partake.
Providing information is a start. While survey respondents showed a clear preference for receiving information about clinical trials from their doctor or other HCP, 49% want to receive information from patients who have previously participated in a clinical trial (especially true for minority patients who haven’t joined a trial before), and almost twice as many preferred to receive information from an advocacy/nonprofit organization or health and wellness website (42%) than from a drug company or advertisement.
In addition to the survey findings, issues like low health literacy and the growing use of the internet for health information point to the need to better engage patient advocacy groups and medical professionals not only in recruiting participants for clinical trials, but also in raising awareness of clinical research as a care option and dispelling common myths that may discourage participation.
Patient communities and advocacy groups can help bridge the knowledge gap to improve health literacy, give patients access to former clinical trial participants, provide information about clinical trial opportunities, and direct patients to the best places where they already are searching for information-online.
To that end, we also need to be smarter about our methods of communicating. Digital solutions provide one avenue to reach patients, but we need to think about how we leverage digital tools to facilitate two-way conversations. While we understand that interpersonal communication with medical professionals is an essential part of the patient recruitment, screening, and consent process, too often we limit important conversations by failing to use all the tools available, like message boards and online communities.
These avenues are important: Our survey revealed that about three in five respondents use message boards and health-based online communities to learn more about their condition and the experiences of other patients. And about two-thirds of melanoma, gastrointestinal disease, lung cancer, lupus, and type 1 diabetes patients use message boards and health-based online communities to learn more about their condition and the experiences of other patients. This is particularly true among younger digital natives.
Yet, as any behavior change specialist can attest, information is not enough. As an industry, we must also remove barriers to participation by considering the burden placed on participants as the trials are designed. The industry needs to include better and more robust mechanisms for patients to participate at early stages of research planning from protocol design to endpoint selection.
This collaborative approach has been supported by the FDA as well. Under PDUFA V, the agency is conducting disease-specific patient-focused drug development (PFDD) meetings with key stakeholders to obtain patient perspectives on specific diseases and treatments. The FDA also supports externally led PFDD meetings such as the Lupus Patient-Focused Drug Development (PFDD) meeting. These meetings and subsequent reports seek to give patients a voice in what researchers are investigating in addition to how the research is conducted.
At the start of the survey project, we set out to answer the question: How can researchers engage patients in a way that makes them feel like stakeholders, rather than subjects, in research? What we learned is that while different patient populations have different specific desires, the underlying theme is that patients want more information from medical professionals, advocacy groups, and their peers.
The key takeaways from our efforts include:
1. Patients want to be well-informed and empowered consumers of health information.
2. We need a more collaborative planning process that incorporates all stakeholders, especially patients.
3. Data and technology companies and collaborations are increasingly important, but a human touch is still necessary.
4. Build lasting relationships with patients for improved retention, repeat study consideration, and continuous process improvement initiatives.
As an industry, we need to do a better job of two-way communication from the start of trial design through to sharing the results. Patients are stakeholders in the research process with an equally strong interest in seeing new treatment options come to market. Yet, the barriers we present to their ability to engage with the research process in a meaningful way outside of clinical trial participation limit this collaboration and may reinforce feelings of unease and distrust. By improving our mechanisms for listening to and engaging patients at all stages of research design in a way that is meaningful to them, we can finally begin to move the needle on patient centricity and truly understand the power the concept holds.
Lindsey Wahlstrom-Edwards, MPH, CPH, is Head of Partnerships, Antidote Technologies Inc.; Anne-Marie Hess is Senior Strategic Advisor and Director of Market Intelligence, SCORR Marketing