Patient Recruitment VIEW on Clinical Services June 2006 Patient Retention and the Power of Praise Anna LeGoff,VP, Patient Retention Liz Moench, President and CEO If overwhelming evidence shows that positive reinforcement can affect worker behavior, what can it do for patients participating in clinical trials? The answer is, plenty. Most companies have some kind of program to recognize outstanding performance for employees, but few companies apply these internal practices to participants of clinical studies; these are the patients who have made an outstanding commitment to study completion. In the workplace, money and fair wages are clearly important, but when it comes to long-term employee happiness and loyalty, it’s truly a case of “you can’t buy me love.” This is the same for study participants. While many clinical teams believe increasing the stipend may enhance or sustain patient retention, money is in fact a short-term motivator. Employees thrive, are motivated, and stick around longer when they are recognized for a job well done; the same goes for patients. But few pharmaceutical-biotech companies apply such principles systematically and effectively to achieve patient retention. In the business-world, CEOs measure the benefits of motivated employees in terms of increases in productivity; managers of clinical trials can measure the benefits of motivated patients in terms of compliance and study completion. A Century of Research A century of research shows a strong correlation between recognition and behavior. If exemplary behavior is recognized and rewarded it will tend to be repeated. But good behavior will stop when it is ignored or not reinforced. In short, you get what you reward. Today, employees perceive themselves as working for people rather than organizations. A good, motivating boss will have employees who are eager to perform. This holds true for clinical research, too. Patients are not enrolling in studies to please their doctor or the sponsoring pharmaceutical-biotech company far from it. If patients have a good experience and a capable healthcare-study team looking out for them they feel the study is a good one for them. They want trust, they want to be shown that their values count, they want to be kept informed about study developments, and they want to be supported for showing initiative (asking questions, completing diaries, etc.). Keeping Patients Happy — Key to Success As we have learned over the past decade, successful programs keep patients coming back for study visits, and minimize discontinuations throughout the clinical study. Patient retention in clinical studies is dependent upon the patients’ satisfaction with the care and attention they receive. As such, every retention program must be tailored to a specific study. Successful retention programs are multidimensional, involving education, support (coping skills, disease information), positive site dynamics, patient recognition, rewards, and a mechanism for monitoring patient feedback for the study team. Best practices that serve as the foundation for establishing strong patient relations throughout the course of the study, include: • Recognizing and rewarding patients (and in some cases caregivers) for compliance with study visits and protocol regimen • Providing information of specific value to patients • Reinforcing the importance of their study participation • Thanking them • Obtaining feedback In summary, enrollment is only half the job; the other and often more challenging aspect of the clinical-trial process is, keeping patients interested and motivated. Top 10 Motivators for Patients Participating in Clinical Trials 1. Full appreciation for returning for study visits and following study instructions directly expressed by the physician investigator as well as the study coordinator. 2. Learning opportunities about their condition and other relevant information that can help them manage their healthcare. 3. Decision-making authority and autonomy — providing patients with the knowledge that study participation is their decision and choice. 4. Flexible visit schedule (within the boundaries of the clinical protocol) to accommodate patients’ schedules. 5. Being kept informed about the study — how many patients are participating in the United States and in the world; how many studies have been conducted; the importance of the study and their participation. 6. Providing feedback, making study participants feel that their opinion counts. 7. Having a sense that their study participation is meaningful and they are making a difference. 7. Feeling part of a study team with great people. 9. A caring study coordinator who provides constructive feedback. 10. Fair pay and compensation for participation. MediciGroup Inc., King of Prussia, Pa., delivers patient-recruitment and retention programs for clinical trials. MediciGroup is certified by the Women’s Business Enterprise National Council. For more information, visit patientrecruitment.com.

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