Do You Need 'Patient' Recruitment?

The problem that no protocol accounts for

Traditional recruitment assumes participants already have a physician. Yet millions don’t - because of cost, insurance loss, rural provider shortages, immigration status, or mistrust. These individuals live with the same conditions but remain absent from site rosters, EHR queries, and referral chains. When the industry recruits only from “patients in care,” the pool shrinks before outreach even begins.

Large segments of the population never become “patients” in the way clinical recruitment defines the term.

The limits of recruiting only from care pathways

Standard feasibility counts treat “people under care” as the total addressable population. That approach collapses in communities with limited primary care access.

Compressed drivers of invisibility:

• No stable PCP due to cost or lack of insurance
• Rural and remote counties with too few clinicians
• Cultural and structural mistrust
• Reliance on urgent care, ED visits, or informal advice instead of longitudinal care

Result: these individuals never surface in EHR mining, specialist referrals, or site-driven outreach.

Who gets left behind

Underrepresentation follows predictable lines such as race, income, and geography. Communities with higher disease burden often have the lowest likelihood of entering formal care, which means they rarely encounter trial information.

Patterns seen across therapeutic areas:

• Lower enrollment among Black, Hispanic/Latino, Indigenous, and low-income groups
• Fewer touchpoints with primary care
• Higher rates of delaying or forgoing care
• Greater reliance on non-clinical sources for health information

If recruitment begins only after a clinician encounter, equity cannot be recovered downstream.

Where standard recruitment stops and people actually start

Many individuals begin their health journeys long before they see a doctor. They search online, join condition forums, talk to advocacy groups, or rely on community networks. This is the invisible stage - the point where interest forms outside the healthcare system.

Invisible-stage behaviors:

• Symptom searching
• Seeking support via advocacy groups
• Exploring alternative explanations when care feels inaccessible
• Looking for options that bypass cost, travel, or insurance
• Researching trials without provider involvement

Expanding beyond the chart: practical outreach

Reaching people outside clinic pathways requires channels built for trust, cultural relevance, and accessibility.

High-impact tactics:

• Advocacy partnerships: culturally aligned, community-based, and trusted sources
• Digital advertising + search: meets individuals where they start gathering information
• Multilingual, low-barrier content: helps people with limited health-system engagement
• Community channels: local organizations, grassroots groups, and peer networks

This shifts recruitment from “finding patients at sites” to “making research visible to people long before they become patients.”

Transition to solution: the invisible stage of recruitment

To restore visibility, sponsors need a framework that operates upstream, long before diagnosis confirmation, before referrals, and before the clinical record exists. This is the purpose of the Invisible Stage Recruitment approach.

Recruitment accelerates when individuals understand research before a clinician is ever involved.

Continue the learning

Explore how to identify and engage individuals who sit outside traditional care pathways.

Visit the Invisible Stage Recruitment page to see the full model for early-stage discovery, community-driven engagement, and pre-diagnosis education.