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29.07.2022 | Insight

HCPs use Twitter to improve clinical trial design, recruitment and equity

By Mary Kangley

Drug development, safety and approval is underpinned by a thorough and multi-faceted clinical trial process. While a field of its own, clinical trial design and recruitment can present a number of barriers to be overcome to produce sufficient data to fulfil regulatory body requirements. Many considerations have to be made, including optimising trial set-up for ease of patient participation, equitable recruitment requirements to challenge existing health disparities, and adequate design to provide rigorous data to instil confidence in prescribing physicians.

Not only is social media a platform to disseminate clinical trial results, especially during congress meetings when the data is published, but it can also be utilised to identify topics of interest for future research and as a vessel to aid recruitment and avoid under-recruitment. There is evidence that proves authors who tweet about their research can increase publicity and citations for their work, as well as to prove that social media can enhance clinical trial recruitment.

CREATION Pinpoint® has a database of over 3 million HCP online profiles (across platforms) and as such can be used to discover what HCPs think about clinical trial recruitment, as well as to explore behaviours they already deploy to contribute to their research. Over the past 12 months (July 2021-July 2022), CREATION Pinpoint® identified over 6,000 HCP authored posts on the topic of clinical trial recruitment in English language globally on Twitter.

Segmenting this HCP conversation, it was clear that equity in clinical trials is discussed most prominently by those in oncology, suggesting this is a pertinent issue for a specialism with an abundance of active trials for new treatments.

A graph showing the most vocal oncologists discussing clinical trials

Tackling under-recruitment

Clinical trials can only be proven successful when there are enough participants to provide statistically significant results, regardless of whether primary endpoints are met or not. HCPs have used social media to discuss concerns about under-recruitment, sharing potential solutions, including simplifying and demystifying trial design to help patients understand what they are signing up for.

One approach taken by HCPs to directly tackle the issue of under-recruitment is to advertise their open trials online, such as psychiatrist Dr James Rucker, who posted a call for participants on Twitter. There were hundreds of similar posts from HCPs advertising clinical trials across a number of therapy areas.

Some HCPs even advertised for trials they were not directly involved in but with which they had an invested interest. One such HCP was Georgia Ede, a psychiatrist exploring the connection between nutrition and mental health who posted about two trials looking at Alzheimer’s and the ketogenic diet. As HCPs build networks of like minded individuals online, they create a prime platform to find the ideal applicants for the trials they share.

Beyond sharing open trials seeking applicants, HCPs also disseminated articles to inspire peers to consider improvements to trial design to avoid under-recruitment issues. Hepatologist Nneka N. Ufere highlighted key points for cirrhosis trials including the use of shared-decision making tools, translated trial documentation and aiming to reduce administrative burden.

Challenging disparities

Inequity in healthcare is an ongoing discussion among HCPs and other stakeholders as exemplified by ASCO’s 2021 annual meeting theme of ‘Equity: Every Patient. Every Day. Everywhere.’  CREATION.co has previously identified multiple areas of inequity HCPs are concerned with, including affordability, patient experience of care and clinical trial enrolment.

Some HCPs have used their online platforms to call to action those placed in a position to challenge existing paradigms, including Dr Ron DePinho, the past president of MD Anderson Cancer Center in Houston, Texas.

Another behaviour observed is of HCPs calling out issues exposed by patient experience, such as Uché Blackstock, an emergency physician in New York who disseminated evidence that 40% of black women with metastatic breast cancer had not been offered clinical trial enrolment as an option in their treatment journey.

Optimising trial design

As they seek to find solutions to challenge these existing paradigms in clinical trial recruitment, HCPs online provide suggestions to optimise trial design. One such HCP was Radiation Oncologist in training Rehema Thomas who, following an educational session addressing structural racism, asked a number of questions to consider when defining clinical trial design.

At ASCO 2022, Haematology-Oncology fellow Adriana Kahn posted key points from a session regarding recruiting for trials in low and middle income countries.

As well as considering how trials are set-up, resourced and maintained to encourage recruitment, a number of HCPs drew attention to the repercussions of insufficient trial data. While some limitations are based on medical ethics and safety considerations, HCPs continue to discuss the implications on eventual patient treatment.

Artyom Korenevsky in Canada candidly explained that some paediatric patients are given drugs off label due to a lack of trials for their age group. He maintained that even though it is difficult to overcome enrolment risks, the threat of not having approved medication for these patients may be worse.

Another affected patient population is geriatric patients, identified in one instance by cardiologist Alfonso Valle, due to many trials only enrolling younger patients, meaning some new drugs don’t have ample evidence for use for those individuals.

Improving paradigms

Overall, Twitter presents a platform for HCPs to define and discuss areas for improvement for the collective goal of optimising clinical trials. The outcome benefits stakeholders beyond only HCPs, from the patient who will receive better treatments, and pharmaceutical companies who can complete more rigorous trials for drug development. By understanding concerns of the consumer in existing trial design, the pharmaceutical industry can work to revise their studies to comply with such requests.

These paradigms of limited recruitment criteria, issues with access to trial information and institutional biases are already being challenged by a number of HCPs and others seeking to challenge them.

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Meet the Author

Mary Kangley

As a Health Insights Consultant Mary is passionate about telling stories with data from online healthcare conversations. Her work is guided by a background in human and cyber-psychology providing a curiosity to understand what HCPs think.

As a keen music fan, Mary’s greatest pride is her Spotify playlists that are continually growing as she makes new discoveries.

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