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.
Trial design determines the future of a study before a single patient is enrolled or a data point is collected.
It influences:
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:
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.
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:
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.
Retention should be a core part of trial design conversations before the protocol is finalized and site selection begins.
At this stage, sponsors can:
Engaging vendors at the trial design or feasibility stage ensures that operational models, technology platforms, and staff are aligned with your retention goals.
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.
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:
Result: Fewer missed appointments, reduced cancellations, and higher patient satisfaction — without burdening site coordinators.
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:
Result: A clinical experience that puts patients at ease — and keeps them engaged visit after visit.
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:
Result: More consistent data collection and better retention across every demographic group, including underserved and at-risk populations.
With our patient-first model, the impact is clear:
This equates to patients staying enrolled, completing assessments, and contributing to the study's success.
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:
The earlier you involve your potential vendor, the more impact they can have on trial success.
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.
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.