How Can I Improve Recruitment for My Struggling Trial?

If your study is behind, the instinct is to spend more on advertising. Sometimes that is right. More often it pours money into a funnel that is leaking further down, and three months later the numbers look the same with a larger invoice attached.

Start with diagnosis instead. It takes about a week.

Step 1: Find out where people are actually disappearing

Pull four numbers per site: referrals received, referrals contacted, visits scheduled, visits attended. Compare against randomizations. In nearly every stalled study one of these gaps is dramatically worse than the others.

Common findings, in rough order of frequency:

Referrals are arriving and nobody is calling them back promptly Patients are being screened against the condition, not the protocol, so they fail at the site Two sites are doing all the work and the rest are dormant Appointment lead times are two weeks and half the bookings evaporate

Only one of those is fixed by more media.

Step 2: Talk to the coordinators, not just the dashboard

Ask three sites what happens when a referral arrives. You will usually hear something the reporting does not capture: referrals landing in a portal nobody has time to open, a phone number that goes to a general line, duplicate records from three sources, or a screening form that takes fifteen minutes to complete per patient.

These are cheap problems to fix and they are invisible from the sponsor's seat.

Step 3: Re-examine the criteria against reality

Pull the screen failure reasons. If the same criterion is responsible for a third of failures, you have a protocol conversation to have, not a recruitment problem to solve. Amendments are painful; enrolling nobody is worse.

Step 4: Fix the middle before adding volume

Same-day contact on every new referral A multi-attempt follow-up cadence with text and email backup Protocol-specific pre-screening before anything reaches the site Appointments booked during the first call, into near-term slots Reminder sequence before every visit

Studies that implement these five without changing media spend at all frequently recover a meaningful share of the gap, because they are converting people they already paid to reach.

A site that has not enrolled in eight weeks needs a conversation, not more referrals. Usually it is capacity, a staffing change, or a competing study. Sometimes the site should be replaced. Routing volume to sites that are converting is often the fastest single improvement in a multi-site program.

Step 6: Only then, scale the top of the funnel

Once contact, screening, and scheduling are working, additional spend converts. Before that, it does not.

What a rescue engagement should look like

Any partner you bring in mid-study should spend their first week diagnosing, not launching. If a vendor proposes a campaign before reviewing your funnel data and screen failure reasons, they are selling media, not enrollment.

We start every rescue with the funnel review, and we will tell you if the problem is something we cannot fix. Request a proposal with your current enrollment data, or contact our team .