A pilot randomized trial of five financial incentive strategies to increase study enrollment and retention rates

Abstract

Background Enrollment and retention difficulties remain major barriers to conducting clinical trials. Financial incentives may promote clinical trial enrollment, however delivery methods to maximize enrollment, maximize retention, and minimize cost remains uncertain. Methods We conducted a single-blind, web-based randomized controlled trial of five financial incentive strategies on enrollment and retention rates in a longitudinal study of advance directives among community-dwelling older adults. Participants were eligible to receive a fixed total financial incentive, but the disbursement amounts at each study timepoint (baseline, 2-weeks, 4-weeks, and 6-weeks) differed between study arms. At each timepoint, participants completed a different advance directive. We conducted an intention-to-treat analysis for the primary and secondary outcomes of enrollment and retention. Results 1803 adults were randomized to one of five incentive strategies: constant n = 361; increasing n = 357; U-shaped n = 361; surprise n = 360; self-select n = 364. Overall, 989 (54.9%) participants elected to enroll in the advance directive study. There were no differences in enrollment rates between the control (constant 53.5%) and any of the four intervention study arms (increasing 54.3%, p = 0.81; U-shaped 57.3%, p = 0.30; surprise 56.9%, p = 0.35; and self-select 52.2%, p = 0.73). There were no differences in retention rates between the control (constant 2.1%) and any of the four intervention study arms (increasing 5.2%, p = 0.09; U-shaped 3.9%, p = 0.23; surprise 2.4%, p = 0.54; self-select 2.1%, p = 0.63). Conclusions Financial incentive programs for trial enrollment informed by behavioral economic insights were no more effective than a constant-payment approach in this web-based pilot study.

Peer supervision experiences of drug sellers in a rural district in East-Central Uganda: a qualitative study

“…It was conducted on a small number of drug sellers with intention to inform quality and e ciency during scale up. Pilot studies are faced with many challenges including estimating with certainty the amount of resources that may be adequate to ensure smooth execution of interventions [40,41]. Similarly, it was hard to estimate the amount of nancial resources to avail peer supervisors for smooth running of peer supervision in this pilot study.…”

A systematic review and meta-analysis of enrollment into ARDS and sepsis trials published between 2009 and 2019 in major journals

“…Surrogates often feel overwhelmed by the acuity of the patient’s illness and substituted judgment process, which influences their decision-making processes for research participation [ 21 ]. Use of ethical and effective behavioral economic nudges during recruitment may help to minimize the surrogate decision-making process and promote informed trial participation [ 22 , 23 ].…”

Peer supervision experiences of drug sellers in a rural district in East-Central Uganda: a qualitative study

“…It was conducted on a small number of drug sellers with intention to inform quality and efficiency during scale up. Pilot studies are faced with many challenges including estimating with certainty the amount of resources that may be adequate to ensure smooth execution of interventions [ 40 , 41 ]. Similarly, it was hard to estimate the amount of financial resources to avail peer supervisors for smooth running of peer supervision in this pilot study.…”