When planning a clinical trial, there's a tendency to focus on enrollment—building lists, recruiting participants, and getting sites up and running quickly. While this is important to hit deadlines (and budgets), what happens after the first patient visit is just as crucial for the trial's success, if not more.
According to industry benchmarks, up to 30% of clinical trial participants drop out before study completion. That level of attrition doesn’t just impact statistical power. It delays timelines, inflates budgets, and threatens the validity of the data you worked so hard to collect.
At 20/20 Onsite, we’ve supported over 34 clinical trials, performed 85,000+ ophthalmic exams, and built a clinical workforce with an average of 11+ years of ophthalmic experience. Most importantly, we’ve created a proven trial design model that has been shown to reduce participant dropout to just 9%.
Retention doesn't happen by accident. It must be built into the trial design itself. Here’s what that looks like and why it matters more than ever in clinical trial design.
Why Trial Design Is the Foundation of Success
Trial design determines the future of a study before a single patient is enrolled or a data point is collected.
It influences:
- How quickly you can recruit
- How consistently patients show up
- How compliant they remain
- How reliable your data will be
- And how long it will take to reach the finish line
Many trial protocols are written for regulatory approval, but not always for operational success, which starts with the patient. Overly complex visit schedules, high patient burdens, limited accessibility, or inflexible logistics all contribute to poor retention. These elements are rarely fixable once the study is live.
A well-designed trial is one that:
- Accounts for real-world patient behavior and constraints
- Enables sites and vendors to execute with confidence
- Builds in flexibility and contingency planning from the start
- Aligns participant experience with protocol integrity
While a regulatory document, the protocol is the blueprint for how every stakeholder, from patient to site to sponsor, will experience the trial. When you design with that mindset, retention becomes much easier to achieve and much harder to lose.
Trial Design and Retention Planning Go Hand in Hand
Retention is not something you can “fix” once you’ve lost participants. By that point, it can be too late. Instead, it needs to be integrated at the earliest stages of trial development—ideally before the protocol is finalized.
When designing a clinical trial, sponsors should consider:
- What are the common barriers to completing the protocol?
- Where can we remove patient friction without compromising data?
Building answers to these questions directly into your study design improves patient experience, reduces compliance risks, and ensures consistent data capture. But to do this well, you must start early.
When Should You Start Thinking About Retention?
Retention should be a core part of trial design conversations before the protocol is finalized and site selection begins.
At this stage, sponsors can:
- Map out participant burden across all touchpoints
- Identify where mobile services could increase accessibility
- Align with vendors to ensure logistics, scheduling, and patient support are ready before recruitment begins
Engaging vendors at the trial design or feasibility stage ensures that operational models, technology platforms, and staff are aligned with your retention goals.
Patient Retention Framework: Built for Patients, Designed for Trials
The 20/20 Onsite retention strategy is rooted in one fundamental belief: patients are people first, not data points. We don’t just provide assessments—we provide comfort, consistency, and confidence throughout the entire clinical experience.
Here’s how we do it.
1. Convenience That Reduces Dropout Before It Starts
Why it matters:
Many participants drop out not because of dissatisfaction, but because of logistical barriers. Long travel times, missed work, caregiving duties, or limited mobility contribute to noncompliance or missed visits. Convenience isn't a luxury. It's a compliance strategy.
Our approach:
- We meet patients where they are – at home, work, or a community site
- Flexible scheduling – evenings and weekends are available to fit the assessment window
- Dedicated scheduling contact – no phone trees, no confusion
Result: Fewer missed appointments, reduced cancellations, and higher patient satisfaction — without burdening site coordinators.
2. Staff That Builds Trust and Reduces Anxiety
Why it matters:
Participants are often anxious, confused, or unsure of what to expect during their first assessments. When rushed, transactional care becomes the norm, and patients disengage.
Our approach:
- Certified clinic managers lead every mobile visit
- One-on-one attention ensures patients feel heard, not herded
- More time per visit reduces anxiety and improves cooperation
- Direct access to staff to answer any questions builds lasting trust and encourages retention
Result: A clinical experience that puts patients at ease — and keeps them engaged visit after visit.
3. An Individualized Experience That Drives Long-Term Engagement
Why it matters:
Trial fatigue is real. Even highly motivated participants can become disengaged over time, especially when protocols are long or repetitive. A generic approach won’t hold attention over months, but personalized care will.
Our approach:
- Tailored pacing and communication for each participant
- Consistent staffing — patients aren’t meeting someone new every visit
- Focus on comfort, clarity, and continuity from the first interaction
Result: More consistent data collection and better retention across every demographic group, including underserved and at-risk populations.
The Numbers Don’t Lie: Retention You Can Count On
With our patient-first model, the impact is clear:
- Patient retention: 91%, compared to 70% industry average
- Potential cost savings: $598,500 for a 150-patient study
- Clinical reach: 85,000+ eye exams performed, 34 trials supported
- Staff experience: 11+ years on average across our clinical team
This equates to patients staying enrolled, completing assessments, and contributing to the study's success.
When to Contact a Vendor
Many sponsors wait until they’re struggling with retention to seek help. By then, much of the trial infrastructure will already be locked in.
The ideal time to engage a vendor focused on patient-centered support is:
- During protocol development – your potential vendor can help assess the burden and design for accessibility
- During site selection and feasibility – your potential vendor should help you identify where mobile support can fill critical gaps
- Before recruitment begins – so logistics, training, and staffing are aligned from day one
The earlier you involve your potential vendor, the more impact they can have on trial success.
Conclusion
Clinical trials don’t succeed because they check all the regulatory boxes. They succeed because they’re designed with the participant in mind.
Convenience, communication, and compassion are the unspoken drivers of clinical trial patient retention and must be incorporated from the start.
Ready to Build a Trial Patients Want to Stay In?
Whether you’re in the early stages of planning or reevaluating an ongoing study, the 20/20 Onsite team is here to help.
Book a conversation with our team and let’s make your trial smoother, faster, and more successful.