This section is going to go over some more examples of real-world recruitment strategies that have been used in clinical trials. Advertising is obviously a very important strategy. It's resource dependent. It might involve centralized efforts like creating materials and advertising and campaigns that are useful to all the sites involved versus local efforts. Who do we want to target? Geographically, if the trial involves people having to come to a particular location, they need to be close to that location and are there particular demographic groups that we are targeting? All advertising, anything that goes before potential participant has to go through an IRB before it's used. Some tips on creating advertising for clinical trial is to ensure that it's visually appealing and attracts the eye. That it's easy to read, you what large bold texts and avoid the fancy fonts even though they may look pretty. You want to include images that are somehow reflective of the study and the study population. You want to try to make it succinct, clear, and at the right level of detail. It's often a good idea to incorporate institutional logos because the logo of the institution can help build credibility for the study. Any advertising should have contact information on it. How does a potential participant reach out to consider enrolling in the trial? It's very important that, that contact information reaches someone and someone responds in a timely manner. Whatever contact information is placed on advertising needs to link participants quickly to the trial. There needs to be a response soon after someone has expressed interest in the trial. This slide depicts a social media strategy that we develop for a study that was reaching out to young adults. The advertising was created to attract young adults. It was targeted to areas around sites. It lead interested individuals to a landing page where they could fill out some information to see if they would be a qualified candidate so that the sites could retrieve that information and follow up with the participant. This slide depicts three different advertisements for a trial with COPD. Each of the three images includes a physician interacting with a participant, but the physician looks different in he images. In one image we have a young woman physician interacting with another woman. In another image, we have a physician interacting with an older gentleman. In the final image we have another physician who's a bit older than the physicians in the prior two pictures interacting with an individual. It turned out that the most popular image was the one that depicted the older gray-haired physician who may have appeared more trustworthy and fit with our expectations of what a physician looks like. Here I've also depicted some of the details about this particular advertising campaign. This slide depicts what a webpage for a study might look like. Again, this is a study that we are doing in collaboration with the American Lung Association so we're able to rely on their media savvy to pick the right pictures of happy people doing the kind of things that would attract millennials' attention. Then there's more content on the page that includes testimonials from participants where they could sign up for the site and the video of one of the lead investigators talking about the study and why this study is important and what the goals of the study are. We also rely on print media. On this slide, I depicted an example of a brochure that you might have in a clinical site or use at a health fair, and it depicts typical patients with COPD and how they were involved in the design of the trial. It has a graphic that depicts the question and also a QR code so that you can quickly scan it and get hooked up with the trial. Another example of a brochure is depicted on this slide. There are several logos depicted on this trial for the American Lung Association, for the National Institute of Health for this particular research group, again, trying to instill trust. There's a lot of words on this particular brochure, perhaps too many, and we also showed images of happy people in the right age group to enroll in this trial. You want to keep the message upbeat even when you're enrolling patients with severe disease in a trial, you still want to be upbeat and uplifting. It's also important to have site-level strategies. Starting with articulating a plan before recruitment is even opened. Whose responsibility will it be to identify patients? Who's going to talk to the patient? What kind of tools are you going to use? Commonly electronic medical records are searched to find patients that are potentially eligible for the trial. I want to caution you to recognize the limitations of these types of searches. Electronic medical records don't always have accurate up-to-date information about what drugs the patient's on or their current clinical condition. So you may be undercutting your efforts if your electronic medical records search is too strict. Many sites maintain registries and have dedicated recruiters. You can have local marketing, such as paid local media, tear-off flyers. In terms of evidence about what works at sites for recruitment, there really isn't much. But what evidence there is, indicates that rapid follow-up, electronic or mail invitations to trials is helpful, open-label trials without masking or blinding are easier to enroll than mass trials, and financial incentives have been shown to be helpful. Well, accepted strategies are the red-carpet treatment. Trials cannot succeed without participants. It's important to recognize that participants are a critical part of the endeavor and to treat them like that. Not to lead them in waiting rooms, or if you have to leave them waiting in the waiting room, give them some forms to fill out. If it's going to be a long appointment, have refreshments, lunch vouchers, parking vouchers. You need extroverted recruiters, people who can reach out and are comfortable interacting with people they don't know and very supportive coordinators. The coordinator needs to be the patient's friend and advocate. Someone the patient feels they can trust and rely on to answer their questions and to help them with any problems or concerns they might have with the trial. There's also the age old strategy of giving out what we call tchotchkes, little favors. I have a slide depicting some of those later. The discussion thus far may have demoralized you a little bit and made you think that you needed a whole media team behind you to enroll in a clinical trial. Any don'ts, some trials are small and don't have the budgets. You have to look at the strengths you have, leverage your existing networks, identify people who can give you access to potential participants. You can use sometimes what we call a snowball strategy, depending on the particular trial and the eligibility criteria. Criteria you can tell participants to tell their friends about the trial. There are very old school type promotions, like the tear-off flyer depicted in this slide that has tabs attached to it, that someone walking by and tear off with information about how they can enroll in the study. Another successful strategy is to reach out to local media to highlight your trial, maybe is a part of their news cast, human interest stories about participating in clinical trial and try to access free and low-cost community papers. You don't have to have a million dollar budget for advertising. You just maybe have to work a little harder and be a little more creative if you don't have as many resources. For example, here's an easy resource that most people could come up with, which is just a pocket card for eligibility to give to clinicians. They don't have to remember who might be eligible for your trial, that they have that information easily at hand. This slide depicts some of the giveaways we use to enhance the visibility of the trial and keep it at the top of participants minds and clinicians minds like backpacks or coffee cups or pens, and sometimes even tools that they may use in the trial like measuring tapes or other items like a notebook. All of these are designed to heighten the visibility of our trial and make sure people are thinking about it, whether there are participant or a clinicians. That's the end of my real-world examples of strategies that have been used in clinical trials that I've been involved in.
