Gamifying clinical trials could motivate participants to engage better with trial platforms and advance research.
Gamification could be a potential solution to addressing patient engagement and compliance in clinical trials, said Christer Nilsson, CEO of Replior.
Nilsson was speaking at the 12th Annual Outsourcing in Clinical Trials & Clinical Trial Supply Nordics meeting that took place in Copenhagen, Denmark 1–2 October. In his opening remarks, Nilsson identified the primary challenges in clinical trials are low patient compliance—70-90% compliance with ePRO or electronic patient-reported outcomes, and high dropout rates (30%) which can lead to high costs and weakened statistics in a clinical trial. High dropout rates in turn can lead to extended timelines and missed market entry and revenue due to delays, said Nilsson.
In such a backdrop, gamification can be “a strategic attempt to enhance systems, services organisations and activities by using game design elements to motivate and engage users in non-game activities”. Gamification works as a strategy as it taps into psychological theories of self-determination, flow theory and behavioral economics, “understanding and harnessing the fundamental drivers of human behavior”, Nilsson said.
Applications in clinical research
In a clinical trial setting, gamification can be used to improve patient adherence to the protocol and minimise dropouts. Additionally, it can be used to enhance both the patient experience and statistical analysis. In turn, the implementation of gamification can ultimately reduce the chances of early study termination and total study costs due to fewer participants and sites, according to Nilsson.
Nilsson emphasised the importance of “Epic Meaning,” which involves making patients feel their participation is crucial for other people suffering from the same disease. According to him, this is most important aspect of gamification as it also enhances the importance of one’s contribution to a study.
Other techniques of gamification hinging on self-accomplishment, empowerment and feedback include the use of trial journey maps, progress bars, and compliance ratings. Additionally, actions like providing disease information, sending reminders and notifications alongside awards and badges, can also be helpful.
“Awards for clear goals and milestones keep building on the Epic Meaning,” he added. Progress bars help visualise how far the patients have gone, and how much time they have already invested in the study, and thus participants are less likely to drop out. Similarly, compliance bars show if participants are performing tasks as expected, and trial journey maps clearly display the next steps.
Gamification data can provide useful insights
Although significant improvements in patient retention and compliance can be achieved using gamification, these strategies can also provide useful insights for the clinical trial organisers. Nilsson said in one study, patient retention increased by 23% compared to previous studies while another study showed a 75% retention rate and 95% compliance rate after increasing the dosage of a drug compound, which previously had led to dropouts.
Touching on the future of gamification, Nilsson said this may include the use of AI, more adaptive gamification implementation, and predictive analysis and risk scoring for dropout and non-compliance . The biggest hurdle in implementing gamification in clinical trials, Nilsson said, is the system support needed to apply gamification and highlighted that sponsors are more likely to buy in than CROs.
