By John Seaner
Fixing the Friction in Trial Enrollment: From Persuasion to Activation
Why do so many patients say “no” to clinical trials?
As our recent webinar made clear, the problem isn’t patient unwillingness–it’s design.
Most people are open to research (70%), but we’ve made saying “yes” too hard.
Clinical Study Success Hinges on Choice
Throughout the clinical trial journey, patients make many choices.
The choice to enroll.
The choice to engage.
The choice to stay.
Therefore, the path to success is through choice architecture + patient activation: applying behavioral science, health literacy, and human-centered design so that enrollment feels clear, safe, and actionable.
Don’t persuade harder– design smarter.
Traditional recruitment pushes more messages, more calls, more ads. A Patient Experience Organization (PXO).approach flips the script: reduce cognitive load, lower decision investment, and build confidence and agency. When we design for how humans actually make choices, they are empowered to say “yes.”
What Drives "Yes"
Patients rarely decline clinical trial participation for one reason–it’s death by a thousand frictions: confusion, fear, overload, and inertia. In our live poll, fear topped the list. And the antidote for fear isn’t more facts–its trust, built through:
Simplification: Plain-language, stepwise experiences (think “TurboTax for consent”) with interactive, modular education.
Choice Architecture: Anchoring, framing, helpful defaults, and social proof (“others like you have participated”)
Human Signals: Real patient stories, authentic imagery, and tactile/digital micro-interactions that reduce cognitive load and boost trust
Care Circle Inclusion: Equip caregivers and site staff with clear tools and scripts so everyone feels prepared.
Measure What Matters: Activation, Not Just Enrollment
Lagging indicators (e.g. randomized counts) don’t tell the whole story. We advocated for composit indexes and early signals to measure things like confidence, comprehension, trust, burden and clarity:
- Experience Index: Recruitment measurement
- Activation Index: Enrollment measurement
- Engagement Index: Retention measurement
Add micro-checks across the journey (quick confidence/comprehension pulses) and use AI where appropriate to detect and resolve friction before it becomes dropout. Consider both qualitative and quantitative metrics. The emotional connection through impactful storytelling is often what unlocks measurable success. Site, patient and caregiver experience feedback can also be a valuable indicator.
Conclusion: Make it Fast and Practical
You don’t need to overhaul everything to see impact:
- Start small: Upgrade consent, add social proof, and introduce default “next best steps.”
- Scale smart: Build multi-layered libraries (portfolio>disease>study) so high-quality, behaviorally informed assets are ready on day one.
- Enable sites: Provide reusable scripts, tools, and engagement cadences that sustain participation–not just at enrollment, but all the way through retention.
- Co-create with communities: Tailor content by age, culture, language, and context and deliver through channels they already trust
Missed the live webinar?
