Keeping oncology patients and caregivers engaged throughout a lengthy trial can be challenging. Study teams need strategies to reduce effort for participants while improving the accuracy and timeliness of the data they provide. Participant input is crucial to evaluating the efficacy of an intervention — from assessing changes in quality of life and determining non-inferiority to crafting labeling claims and marketing messaging.
Electronic patient-reported outcomes (ePROs) are one of the best ways to tune in to patient and caregiver needs. But ePROs are valuable only when participants can consistently (and easily) provide this information. By incorporating behavioral science principles into an ePRO platform, oncology trials can increase the likelihood that patients stay actively engaged. These principles also help ensure that a trial is capturing robust, complete data — even when it spans multiple years.
Behavioral science: The study of human decision making
Over the past two decades, this discipline has moved from the confines of academia to influence everything from government and multinational policy to public health and business intelligence. Behavioral science principles tap into the neurobiology of reward. They help explain how and why people make decisions. And they point to tangible strategies to maximize the benefits and decrease the burdens of staying active and compliant in an oncology study.
What follows are three specific ways to do that.
Strategy #1: Build participant identity
Behavioral science research has affirmed that identity is an intrinsic motivator. Using the "identity lock" process helps connect a patient's sense of self to their participation in an oncology study. It requires a shift from treating a participant as a study subject to focusing on their role as a partner and scientific contributor to the clinical trial.
When a participant makes a study part of their personal identity, they are proud to share that "I'm an oncology hero" or "I'm helping to fight cancer." Once an individual has embraced this identity, dropping out of the study becomes more difficult.
There are several ways to operationalize identity lock using technology and communications. Incorporating patient-engagement content has been shown to increase participant satisfaction and feelings of involvement, which are associated with better compliance.
Strategy #2: Create motivational intervals
Motivation is critical for participant engagement, compliance and retention. Behavioral science research has increased our understanding on reward learning — a kind of reinforcement learning occurring at multiple timescales. The length of the typical oncology trial necessitates long-term motivation. We also know that oncology study participants' experiences in the first weeks and months of the study are critical for the forming of a habit of participation of compliance. To address these realities, create motivation at three intervals.
Short-term motivation should include a combination of reflexive and cognitive reinforcers. These rewards are immediate and tied to completion of individual study activities (such as completing an ePRO or an eDiary entry).
Medium-term motivation reinforces study progress. Medium-term rewards build an expectation of future rewards. Using anticipation with medium-term rewards helps people to stay in the study and continue completing activities.
Long-term motivation focuses on meaningful goals tied to study completion. It aligns those goals to larger, rarer and more tangible rewards. Aim for creativity with long-term rewards. For instance, consider offering participants the opportunity to donate to a disease-specific organization. This reward powerfully combines meaningful goals and personal identity.
Strategy #3: Reduce friction using mobile technology
Infusing behavioral science principles into a mobile platform is an effective way to reduce friction for oncology trial participants. In addition to helping set expectations and minimize burden for participants, a mobile platform can be used for default setting. Default setting is a behavioral science principle at work in everything from organ donation programs to retirement plan participation.
Mobile technology also helps eliminate missing data by decentralizing collection of eCOA/ePRO, eConsent and eDiaries. Participants can provide information anytime, anywhere with just a few clicks on their mobile device. Mobile technology helps improve data insights, too. Given the need for remote monitoring in oncology trials, passive data collection via mobile devices offers many advantages. Phone-based metrics, such as battery life and screen time, which can provide real-world data indicative of participant engagement and quality-of-life changes without any effort from the participant.
The payoff of stronger patient engagement
Oncology studies can apply behavioral science principles — and bring them to life through mobile technology — to strengthen patient engagement. Stronger engagement translates to higher compliance and retention rates, improved data collection and better real-time visibility for study stakeholders