Contributed Commentary By Jeff Lee

February 20, 2019 | The use of mobile technology in clinical trials is becoming increasingly prevalent, most notably in collecting electronic clinical outcome assessment (eCOA) data. Its role, however, in improving patient engagement throughout an entire study is a lesser known area, and an opportunity for differentiation.

Three reasons stand out why mobile technology aids patient engagement so significantly:

Firstly, mobile is everywhere. Everyone knows how integral mobile technology has become to our daily lives, but you may not realize quite how ubiquitous it really is. An average person spends five hours a day on their smartphone, with more than half picking up their smartphone within moments of waking up in the morning. In fact, studies have shown that smartphone users view their device over 500 times per day. Consequently, over a typical 16-hour waking day, mobile technology offers more visibility to patients than any other platform. Tapping into this direct line to patients allows sponsors and CROs to subtly introduce trial activities (e.g. protocol instructions, video guides on home self-injection procedures) seamlessly into the normal flow of patients’ lives. By doing this, sponsors not only help patients understand what they must do in a study, they feel empowered and more invested in its success, which ultimately reduces the incidence of drop out from a study. Being so embedded is an opportunity the industry cannot afford to miss.

Secondly, patients expect technology. Today’s consumers are experienced—and skeptical. No one today would comfortably enter their credit card details into a website that looks like it was built in the 1990s. On the other hand, a modern and sleek website with proper security protocols, forms, and communication, fosters confidence in how personal data is being managed, ultimately making people more likely to proceed. Now imagine instead of making a purchase online, we are asking patients to trust us with their health, using investigational therapies—and then we present to them stacks of paper binders and outdated, clunky software. This cannot inspire confidence in people who expect and demand a clean technology from the most basic of their daily tasks in order to  have trust.

For the pharma industry, developments are in play that can optimize the patient experience beyond simply delivering a range of apps. Leading technology innovators are involved with integrations of several third-party services into one app to create one simple interface for patients (and sites and study teams). Such integrations that meet the needs of patients include ePRO and eCOA data capture, eConsent, patient engagement, patient payments, courier and travel services, and home health nursing. This eliminates an excess of disparate technological interactions with websites, apps, SMS alerts or emails which, despite best intentions, often overwhelm patients rather than reduce the burden of participation. Such seamless interaction, bringing systems to patients that reflect and respect patient-centricity, cannot be underestimated for the value of technology in building confidence in how well studies are managed. Patients have enough to deal with managing their health situation, so minimizing logistical burdens by combining as many solutions as possible into a single app, not only eases the daily burden of participation, it also meets—or exceeds—the expectation of a quality trial.

Finally, mobile technology lets you get creative. Beyond the known benefits of visit reminders, medication compliance alerts, and study notifications, mobile technology can deliver exciting new possibilities. For example, in a recent smoking cessation study, gamification was used to engage with the adolescent patient population. A game involved an adventurer searching for a lost city and the further patients progressed in the study, the more of the story they were able to see with each new chapter revealed at each study visit. A simple yet effective concept, the game proved a powerful engagement tool for patients. This type of content can also be culturally adapted to demonstrate sponsor awareness of subtle cultural difference.

Controlled image and audio capture is another exciting opportunity for researchers, given the high resolution of cameras on most smartphones today. Utilizing such technology can be particularly helpful to assess dermatological conditions such as psoriasis, or to better evaluate reactions to injection-based therapies, such as vaccines. Guides on capturing clinically accessible images for study teams can also be developed as a built-in feature to support patients through such aspects, similarly with audio and capture of precisely calibrated sound recordings to assess conditions such as Parkinson’s or Friedreich’s Ataxia where speech or phonation patterns can be impacted by the disease.

Other possibilities include lay summaries and access to data that don’t risk bias or unblinding, cultural interpretation of images (e.g. using manga cartoons in Japan), trial updates such as final patient completion and regulatory submission, as well as simple expressions of gratitude towards patients. Each of these helps the patient receive not only more value from their involvement in the study, but equally importantly feel more valued by the study.

In summary, much is being done to push the boundaries on what is possible in patient engagement by best-of-breed vendors, going beyond standard industry features. There is a huge opportunity to engage patients in clinical trials through mobile technology and greatly improve study outcomes. With growing evidence that patient engagement is not only synonymous with increased patient retention, but part of the actual conduct of study, is it really something that any sponsor can afford not to make a strategic priority, both to improve the patient experience and their own ROI in clinical trials worldwide?

Jeff Lee is Product Lead for Patient Engagement and eConsent at CRF Bracket, a leading clinical trial technology and specialty services provider. Jeff joined CRF Bracket in 2017, following the acquisition of his company, mProve Health, which he founded 2010. As CEO of mProve Health, a leading provider mobile technologies for patient recruitment, engagement, and data collection in clinical research studies, Jeff grew the company globally. He can be reached at Jeff.lee@bracketglobal.com