Patient Recruitment in Clinical Trials: It Starts with Better Design

Patient Recruitment in Clinical Trials: It Starts with Better Design

Patient recruitment remains one of the biggest causes of clinical trial delays. So why, after decades of investment, innovation and expertise, does the industry still struggle to solve it? In this episode of Digital Health: Off the Record, Edwin Cohen and Farrell Healion are joined by patient recruitment specialist and author Ross Jackson. Ross challenges the idea that recruitment is primarily an advertising problem. The conversation explores why recruitment and retention must be considered from the earliest stages of trial design, the critical role sites continue to play, and why opening more sites is rarely a complete solution. The discussion also looks at recruitment costs and commercial models, the growing use of AI, and how digital twins and synthetic control arms could transform the number and type of patients required for future trials. What we cover: * Why recruitment must begin with trial design - 01:13 * How patient outreach and access have evolved - 04:04 * Why sites remain central to recruitment success - 13:20 * Understanding site performance and where to focus - 17:26 * The cost of recruitment and different pricing models - 20:10 * How AI is changing patient identification and engagement - 26:04 * Digital twins, synthetic controls and the future of trials - 30:24 * Designing trials for patients, not around them - 34:00 Ross leaves us with a simple but powerful principle: design every trial as though it were for you or someone you love.

Site Payments and Patient Reimbursement: Who Carries the Cost?

Clinical trials cannot run without research sites and participants. Yet both can end up carrying significant costs while waiting to be reimbursed. In this episode of Digital Health Off the Record, Edwin and Farrell explore the often-overlooked realities of payments in clinical trials. From site budgets that fail to capture the true workload to patient expenses that can become barriers to participation, they discuss why getting payments right is essential for sustainable and accessible research. Building on previous conversations about site burden, patient-centred trial design and fragmented technology, they also consider whether digital payment tools are genuinely simplifying the process or creating another system for sites to manage. In this episode, we cover: * Why timely and fair site payments matter - 00:51 * The hidden work that trial budgets can overlook - 03:02 * Payment delays and their impact on site cash flow - 14:37 * Patient reimbursement and barriers to participation - 19:12 * Technology, ethics and planning for long-term costs - 23:58

Patient Voice in Clinical Trial Design: Recruitment, Retention and Real-World Burden

Patient centricity is not a new topic in clinical trials, but it is one the industry still needs to keep coming back to. In this episode of Digital Health Off the Record, Farrell Healion and Edwin Cohen explore why incorporating patient voice earlier in study design can make a real difference to recruitment, retention and the overall patient experience. We discuss how patient input can help reduce unnecessary burden, improve protocol design, support more meaningful inclusion criteria and make trials work better around real life. We also look at where digital health technologies, DCT capabilities, patient feedback tools and patient engagement roles can help - and where simply adding more technology risks creating the opposite effect. As always, this is an honest conversation about what the industry is getting right, where we still fall short and how we can design better trials for patients, sites and sponsors. In this episode, we cover: * Why patient voice matters for recruitment, retention and study success 00:25 * How earlier patient input can improve protocol design and reduce burden 03:50 * Designing trials around real-world patient needs, diversity and access 05:46 * The role of DCTs, digital tools and patient feedback in improving the trial experience 12:55 * Why patient centricity still struggles to stick in practice 21:10 * Balancing standardisation with meaningful flexibility in global trials 25:26

eConsent in Clinical Trials: More Than a Digital Signature

eConsent has been discussed in clinical trials for years, but it still feels underused compared with other patient-facing technologies like eCOA. In this episode of Digital Health Off the Record, Farrell and Edwin take a practical look at what eConsent really means, why it should be more than a PDF with an electronic signature, and how it can improve the consent experience for patients, sites and sponsors. We discuss: * Why eConsent still has not reached its full potential (00:24) * What eConsent should mean beyond a digital signature (01:17) * How eConsent can improve patient understanding and accessibility (03:45) * Why consent should be treated as a workflow, not just a document (05:17) * The hidden value of optional consent, data use and sample traceability (07:24) * Why consent forms remain too long, complex and difficult to manage (10:27) * How digital workflows can support amendments, reconsent and oversight (19:20) * Why digital consent is often held to a higher standard than paper (22:17) As with our previous discussions on eCOA and DCT-enabling technologies, the real opportunity is not simply to digitise an existing paper process. It is to rethink how clinical trial technology can make studies clearer, more accessible and easier to manage for everyone involved.

eCOA in Clinical Trials: Why Implementation Still Makes or Breaks Digital Patient Data

eCOA has been part of clinical trials for decades, but it still has not reached its full potential. In this episode of Digital Health Off the Record, Farrell and Edwin go back to basics on electronic clinical outcome assessments - what eCOA actually covers, how it differs from eDiaries and remote patient monitoring, and why it is about much more than just ePRO. They also get into the practical side of eCOA implementation, including why paper still appears in study discussions, where hidden costs and data integrity risks come from, and how better planning can remove licensing, translations, submissions and device strategy from the critical path. We cover: * What eCOA means across ePRO, ClinRO, ObsRO and PerfO [01:20] * How eCOA can support primary and secondary endpoints [03:46] * Why eDiaries and remote patient monitoring are related, but not the same thing [04:34] * The history of eCOA and the move from paper to digital [06:17] * The real cost comparison between paper and digital data capture [07:48] * “Parking lot syndrome” and why timestamps matter [09:33] * BYOD vs provisioned devices, including patient preference and reimbursement [11:10] * Sustainability considerations for study devices [15:43] * Why eCOA implementation often goes wrong [17:37] * Why licensing, translations and submissions can delay study start-up [18:10] * China-specific implementation considerations [21:00] * Accessibility, caregiver support and assisted completion [23:53] * Why paper introduces more risk than many teams realise [25:35] Ultimately, eCOA is not just a technology choice. It is an implementation, data quality and patient experience decision.