To successfully complete recruitment on schedule, clinical research studies need to generate and keep momentum.
To lose momentum can significantly delay or kill a trial. The momentum / motivation relationship is interesting because not only can momentum affect motivation, but conversely motivation can affect momentum. They are linked in a continuous cycle.
Delays in a study cause a loss in momentum and that can directly decrease site and investigator motivation. Flip that around and decreases in motivation can bring momentum in recruitment to a crashing halt. They have this cyclical relationship and if you pull out one link in the momentum-motivation chain, the cycle becomes unstable.
It’s kind of like those torture devices we had on kids’ playgrounds back when I was young. Depending on your age, you might remember the teeter-totter (aka seesaw). Whomever designed this equipment of destruction must have been a big kid in their youth because a kid like me who was small growing up could never have imagined or constructed such an evil device. The premise of the teeter-totter is that you would have this board laid across a fulcrum and two children would sit on either end of the plank and gently rock up and down, ideally saying “weeee” whilst both enjoyed the cooperative piece of equipment. Reality check – there was always a big kid on one end (my older brother) and a little kid on the other (me). The big kid would sit on one end and thanks to the weight differential their end of the plank would be on the ground. The little kid would be 30 feet in the air uncomfortably pressed against the handle post at an unfortunate angle. After the big kid got tired of terrorizing the little kid by suspending them from such horrific heights, the big kid would simply get off the teeter-totter and send the little kid plummeting to the ground likely breaking limbs or teeth. It does make one wonder why I kept getting on the teeter-totter, but that’s likely best discussed with my therapist.
Wow – long story short – Momentum and motivation are on the ends of the teeter-totter – best kept in complete balance. If momentum gets knocked off the clinical trial teeter-totter, motivation crashes to the ground (and vice-versa). That can be disastrous for your study.
This article series will explore the four “I”s of investigator motivation: Impediments, Irritations, Involvement and Importance. As Impediments and Irritation increase and Involvement and Importance decrease, motivation also decreases.
Ideally, sponsors need to work to minimize Impediments and Irritation. Effective communication and good planning elevate Involvement and Importance. I’d love to hear from you as I work through this important topic. Share your stories of momentum and motivation killers and builders.
Factors that Affect Investigator / Site Motivation (Article links):
Impediments: Avoid the things that keep the clinical trial from starting or running smoothly.
Irritations: Decrease the the irritating factors that drive sites to quietly quit the clinical trial.
Involvement: Increase the engagement and involvement of sites to drive better enrollment outcomes.
Importance: Ensure that the site knows they are important and share the story of how important the study is.
Clinical Research 