Clinical trial support tends to be treated as two separate phases:
But between those two phases is an under-supported window that can erode recruitment efficiency before typical retention strategies have even been introduced.
This is the ‘last mile’ of recruitment, or enrolment phase: the decision-making window where someone has been made aware of a trial they may be eligible for but hasn’t yet committed to participating.
And it’s not a minor phase. It’s where patients and their families decide whether participation feels clear, feasible, and worth it in the context of real life. It’s also where sites end up doing the heavy lifting of expectation-setting and reassurance, often with limited time.
In recent months, our research team has focused on this ‘last mile’: what makes eligible, interested patients and families hesitate, and where support currently falls short.
To keep this grounded in real clinical workflows, we spoke with Chloe Lane, a Paediatric Research Nurse, as an external subject matter expert, alongside people who have first-hand experience of considering participation in clinical trials.
“Enrolling onto a clinical trial can be a huge commitment and there are lots of factors to consider; particularly when it comes to children and their families. When we provide holistic support in the enrolment stage, we can begin to build trusting relationships, which can directly improve patient retention and trial success.”
- Chloe Lane, Paediatric Research Nurse
In a typical trial, the enrolment phase is supported through some combination of:
These elements are essential but they’re not always sufficient, and they’re rarely designed as a coherent patient experience. They can feel like ‘information’ rather than ‘support’ that helps families with practical decision making.
Information overload is a common challenge, with research staff often having to break documents down themselves to make information more digestible for families.
“I'll break it down quite simply and then put it into a table format or list to the families what's expected of them when they come in. This might be blood test first thing, followed by this, this and this… They're always super, super grateful for that”
- Chloe Lane, Paediatric Research Nurse
Across the insights we gathered, the friction points tend to cluster into six areas.
1) Screening in an unknown “black box”
Many people assume being approached about a trial means they will be enrolled. The steps between interest, screening, and consent aren’t widely understood.
When different screening outcomes aren’t clearly explained upfront, patients and their caregivers can feel disoriented, even if the process is appropriate and ethical. Sponsors and sites then carry the downstream cost: disappointment, drop-off, and reduced trust within patient communities.
"We were really keen to get on the trial […] having multiple steps (things to do) during this time can add to the worry about whether you’ll be accepted onto the trial.”
– Caregiver feedback on trial experience
The enrolment phase often begins with long documents and new, complex concepts. Even highly engaged potential participants can struggle to interpret what matters now versus what can wait.
Patients and their families need an accessible starting point: What is this trial? Why me? What does participation look like? What are the real trade-offs?
Even when someone is interested, their decision can hinge on feasibility:
These are the details that determine whether participation is realistic - and they’re not always communicated early enough, consistently enough, or in a way people can act on.
Patients, and their wider family and support network, often have concerns they don’t voice. They may feel unsure what’s appropriate to ask, worry about appearing difficult, or simply not know what questions matter until later.
Often that means the people who most need reassurance can be the least likely to request it.
The last mile isn’t only about getting to “yes.” It also includes what happens when a patient becomes ineligible, fails screening, or decides not to proceed.
A respectful offboarding experience protects trust, strengthens your reputation with patient communities, and supports future willingness to engage with research.
In reality, research teams are often:
This work is valuable, but time consuming. It also varies depending on staff capacity and experience, creating inconsistency in participant experience across sites.
The clinical research industry hasn’t consistently operationalised the ‘last mile’ as a defined phase with its own needs, success criteria, and support components.
If sponsors can treat the enrolment phase as a deliberate part of recruitment, then pre-enrolment support can become a driver for:
Based on our research insights, effective last mile support should:
These needs map directly to the six friction points we saw most often.
The ‘last mile’ of recruitment is where decisions are still being made, and small improvements to the level of support can have outsized impact for patient experience and trial outcomes.
“As a paediatric nurse working in clinical research, I felt as though the team at Little Journey truly valued my insight, experience and feedback in these early stages of product development. This commitment to collaboration gives me confidence that they will positively contribute to the experiences and outcomes for children and their families and it is exciting to know that such products are in development.”
- Chloe Lane, Paediatric Research Nurse
If your team is working to improve recruitment rates, patient experience, and trial efficiencies - without increasing site burden - we’d love to chat about how Trial Flow can help.