Clinical trials today are broken. Trial performance is sinking while costs rise and innovation lags. To better support clinical trial sponsors in trial participant recruitment and retention, the COGNITIVE by ZS team commissioned research aimed at understanding the cognitive barriers principal investigators (PIs) and clinical research coordinators (CRCs) experience and how their behavior can influence clinical trial success. PIs play a major decision-making role in recruitment, while CRCs are more focused on retention and have more frequent day-to-day interactions with enrolled patients.


This research, which used concepts from health decision science and medical decision-making, was a follow-up to our 2021 Study of Underrepresented Patients for Equity in Recruiting (SUPER), which examined patient willingness to participate in clinical trials. The objective for this new study was to identify cognitive factors that feed into PI and CRC behavior. Our research also identified several challenges to successful patient recruitment and retention that can lead to suboptimal outcomes and strategies for overcoming those hurdles.