Do you really know what you're doing?

My experience with central advertising companies is that they don't always seem to be worth the money that I'm sure the sponsor is paying for their services. Often times an advertising company will present itself as the guaranteed solution to slow enrollment, but most of the time that promise does not pan out. If it does work I would wager that it is because the study actually is not that difficult to enroll and the sponsor could save significant resources by leaving enrollment in the hands of the sites.

From a site's perspective the idea of central recruitment is extremely convenient: ads are run by a company, calls from the ads go to a call center, calls are screened for eligibility, those that qualify are sent to site via fax/email/whatever. However, the call center may not actually be accurately screening those callers because they do not have an intimate knowledge of the study, only a checklist with sponsor designed questions. Furthermore those call center employees do not have the ability to start establishing a relationship between the site and the potential trial subject that a site based recruiter or coordinator does (that initial recruitment relationship is vital to the success of not only recruitment for one study, but also the site's rapport within the community). I think that if people hear the ads they are going to call in regardless of who places them, so the responsibility really falls on the person receiving and screening the calls to make sure that no potentially eligible participant is left out of the mix. Unfortunately because of the rigidity of call center phone screening scripts, that is not the case.

Companies that generate and place ads are a step in the right direction because calls go directly to the site, but they still are lacking and in some cases a waste of the sponsor's money. Again as indicated above, if a study is difficult to enroll advertising will not make a difference, no matter who implements the advertising plan. There needs to be more discussion with the sites as to what works in an area, what the demographic is, and what times the site is available to handle calls because advertising companies will often go off on their own with what they believe is the best way to advertise in a region (even if they are located elsewhere and don't have a good idea about demographics). The study sponsors pay good money for these services, wouldn't you think there would be more of an effort to really tailor the advertising to a specific site or region?

So what is the solution? For starters if a site wants to recruit on its own, the sponsor should give the site the resources to do so. Most sites with active recruitment departments are good at what they do and will be able to garner more phone calls if they are free to advertise as they choose. Sponsors should not assume that there is one recruitment method that will work for all sites.

Next sponsors should really do their homework in pre-study visits (Don't just take the site's word for it that they have X number of potential people in their database. Ask for a physical lists of potential participants, get a pre-screening log started well in advance of the visit, ask for enrollment numbers on previous studies, discuss the study at length with the PI).

Finally the importance of physician referrals should not ever be understated. It is absolutely critical that the investigator is conscience of the study and its need for participants. Sites and sponsors alike would agree that the best type of recruitment is when a physician investigator asks his patient if he/she is interested in a trial. The best recruiter in the world can never replace a good personal referral by an investigator.