7 Steps to Improve Participant Retention in Clinical Trials
Summary of Article
Participant retention in clinical trials improves when studies reduce participant burden, increase understanding, and maintain consistent engagement. Proven strategies include remote participation tools, video-based eConsent, clear patient education, flexible scheduling, automated reminders, and compensation for time and travel. High retention protects data integrity, reduces delays, and lowers trial costs.
What is Patient Retention and What Does It Mean for Clinical Trials?
Participant retention in clinical trials refers to the ability to keep enrolled participants actively engaged and compliant throughout the duration of a study. High retention ensures data completeness, statistical validity, regulatory confidence, and timely trial completion.
Why Participant Retention is Critical for Clinical Trials
Poor participant retention can lead to:
- Incomplete or biased data sets
- Extended study timelines and higher operational costs
- Loss of statistical power
- Increased protocol amendments
- Delays in regulatory submission and approval
High retention improves:
- Data quality and consistency
- Patient safety monitoring
- Trial efficiency and predictability
- Sponsor and CRO confidence
Pre COVID-19 retention challenges
Under normal circumstances participant retention is a challenge, with only 7 out of 31 enrolled participants, on average, complete a trial. The most common reasons are the following:
- The participant misunderstood the original trial purpose or protocol and is no longer interested in participating.
- The participant is afraid or anxious about the clinical trial.
- The test is being conducted at an inconvenient time or location.
- The participant is physically unable to attend the trial, or their condition isn’t improving.
- The participant simply forgets their schedule, refuses to follow directions or changes their mind entirely.
Recruiting patients to participate in clinical trials is beset by challenges as well since there are so many misconceptions about them, like:
- It’s going to take a lot of time.
- It’ll be painful and only helps future patients.
- I’ll only be given a placebo, so what’s the point?
- I’m just going to be a lab rat.
As you might expect, COVID-19 has only served to exacerbate these challenges.
Recommendations on Improving Participant Retention in Clinical Trials
Here are seven key points clinical trial managers should consider to help improve participant retention.
- Offer remote engagement: According to recent studies, most patients have no problem using technology to remotely participate in a clinical trial. Multimedia tools such as telehealth, video education, patient engagement software, comprehension testing, and eConsent software can help convert and retain more participants.
- Ensure patient understanding: Take some extra time to make sure your patients understand any new rules, directions or expectations. Nuances like wearing a mask might be unfamiliar to them, so it’s important to clarify any requirements before their visit. When working with technology, especially during virtualized clinical trials, give your participants a step-by-step guide to help them efficiently interact with the technologies deployed. Patient engagement software should be a minimum.
- Provide timely reminders: Cut down on “no shows” and utilize technology such as text messaging to consistently remind participants about their next scheduled appointment. Patient engagement and eConsent software even provides text messaging – a proven effective way to communicate new safety expectations and processes recently implemented by the site(s).
- Include video as part of your eConsent process: Include multimedia capabilities such as video and informational documents that help educate participants of key study protocols, procedures and expectations. In an article published by Otsuka Pharmaceutical, internal data analysis indicated there was a correlation between participants who spent more time on the video and those who completed the study, suggesting that watching the video may help improve retention rates.
- Provide flexibility in scheduling: As mentioned earlier, many patients specifically cite scheduling conflicts as a reason for dropping out of previous clinical trials. To avoid this, try to offer as much flexibility as possible when it comes to scheduling. Virtualization can help a lot here, but you’ll probably need to maintain some semblance of regular business hours. Again, technologies such as eConsent software can be of great help.
- Compensate patients for travel costs: In some cases, patients can’t attend your clinical trials because they simply can’t afford to travel back and forth. With this in mind, you might think about offering them reasonable compensation.
- Facilitate continuous treatment: If you have trial participants who need further or ongoing treatment, or if their conditions aren’t improving over time, it might be worthwhile to offer continuous treatment. Apart from being a great way to reward a dedicated trial participant, it can also help solidify a positive reputation in the surrounding communities.
Clinical Trial Use Cases for Participant Retention Strategies
These retention strategies are especially effective in:
- Oncology and rare disease trials
- Decentralized and hybrid clinical trials
- Long-duration or multi-visit studies
- Trials involving complex treatment regimens
- Studies requiring high protocol adherence
- Global or multilingual participant populations
Conclusion
Improving participant retention in clinical trials requires a patient-centered approach that prioritizes understanding, accessibility, and ongoing engagement. By combining remote participation, video-based education, flexible scheduling, and consistent communication, sponsors and research teams can reduce dropout rates, protect data quality, and complete studies more efficiently.
Participant Retention in Clinical Trials: FAQs
Common causes include travel burden from frequent in-person visits, limited understanding of study requirements or procedures, inconsistent communication with the study team, scheduling conflicts with work or caregiving responsibilities, and unexpected out-of-pocket costs such as transportation or parking. Anxiety, fatigue, and uncertainty about treatment expectations can also contribute to early withdrawal, particularly in long or complex studies.
Video education can improve clinical trial retention by increasing participant comprehension and confidence at every stage of the study. Visual and spoken explanations help participants better understand procedures, risks, timelines, and expectations compared to text-only materials. Video content can reduce anxiety, reinforce informed consent, and ensure consistent messaging across study sites. When participants clearly understand what will happen and why, they are more likely to remain engaged, adhere to protocols, and complete the study.
