Getting the most from a central advertising campaign
There are few Patient Recruitment and Retention (PRR) tactics that are more controversial than the central advertising campaign. Although central advertising can cover several different mediums such as television, print, radio and online, most users fall into one of two groups: the “it worked” group or the “it didn’t work” group. This dichotomy is pronounced regardless of factors unique to each clinical trial, and hamper efforts to broaden the use of advertising for clinical trials. There are many factors that drive these strong opinions, including cost, the communication of expectations and the accountability of the study sites.
One of the more pervasive objections to advertising is the cost. It’s easy to understand initial sticker shock of those encountering an unfamiliar tactic. Central advertising campaigns are developed for all the clinical trial sites and not initiated by the sites themselves.
A centralized campaign leverages efficiencies and ensures that recruitment messaging remains constant. Don’t simply give 150 different sites $5,000 each to do any type of advertising they wish. Doing so would results in an end total of $750,000, far beyond most budgets.
In order to get a real sense of the advertising dollar value, look at cost per patient. Arriving at cost per patient is simple with advertising: Take the total cost of the advertising and divide by the number of referred, screened and randomized patients. In the central campaign example above, if each of the 150 sites received only one patient from the central advertising, the cost per patient would be significantly lower at $3,333 per patient. (See Chart)
This same principle should also be applied when opening up a site. Many study managers attempt to solve recruitment predicaments by opening more sites. Identifying and opening new sites can be time consuming and expensive, especially when the recruitment window is closing. If it costs $40,000 and four months to initiate a new site and those sites deliver two patients, then opening a new site cost $20,000 per patient.
The expectations of an advertising campaign should be communicated both early and often. A rule of thumb that can be applied to most studies is that the sites will be able to supply 80% of patients from within their database. This seems like justification for eschewing the need of a central advertising campaign, right? Wrong. If your goal is 100% enrollment, then the 20% gap must be filled. Central advertising campaigns can fill that gap. For the conservative study managers not convinced that central advertising campaigns will work, the central campaign may be held back and launched only as a contingency tactic once recruitment falls below a defined trigger point. To set realistic expectations up front, it is essential to develop a basic patient funnel that shows the expected number of people in your target demographic, percent of reach to that demographic, estimated screen fail rate and estimated conversion rate of interest to randomization. If the goal of two patients per sites isn’t expressly presented, the low number of enrolled could be viewed as “not working.”
Site accountability is a huge part of the success of a central recruitment campaign and can be the number one reason that a study manager gets the wrong impression about central advertising campaigns. There are many instances where a study manager has claimed “the advertising didn’t work” when it fact the advertising did work, but the sites did not. In these instances, advertising does its job of generating study awareness and interest, but none of the interest is followed up on by the site. When pre-qualified referrals are sent to a site, site staff should follow up with that inquiry within 48 hours because interest naturally wanes over time. When sites sit on referrals for a long period of time or worse, never follow through at all, it not only puts the wrong message to the study team that the advertising is not working, it also damages the chance that the interested person will ever show interest in another clinical trial.
Having a mechanism in place to ensure sites are held accountable to follow up on the interest generated from a central campaign is critical to success. A reporting system—or simple Media Response tracking sheet—that is developed with the team and study sites, can help establish what the team agrees to be expected results from the media buy, as well as the data that sites need to collect and provide back to the Recruitment and Retention team in order to optimize the media buys and improve performance and ROI.
Once the team agrees on the metrics that will be tracked, and the definition of success, clear and frequent communications to the sites will improve site accountability. Multiple methods—weekly CRA communication, monthly newsletters, and live info sessions—to let sites know what media is running, the dates of the advertising, as well as the dates/process for updating referral outcomes will increase the understanding and buy-in from the sites.
Don’t forget to share the results with sites! Let local study teams know when media campaigns go well.
Ashley Tointon has more than 18 years of patient recruitment and project management experience supporting clinical trials and the pharmaceutical industry. Currently she provides recruitment expertise, strategy and leadership as Principal Consultant of Accelerate Clinical Enrollment. Email comments and suggestions to firstname.lastname@example.org.
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