How Decentralized Clinical Trials Help Keep Patients Engaged and Retained

Recruiting the right patients is only the beginning of a successful clinical trial. Keeping those patients engaged through their final study visit can be just as challenging.

Traditional clinical trials can ask a lot of participants: repeated travel to research sites, time away from work and family, transportation expenses, lengthy visits, and frequent assessments. These demands can accumulate over the course of a study and ultimately contribute to participant dropout.

A decentralized clinical trial (DCT) approach can help reduce that burden by bringing more study activities to participants—at home, in their community, or wherever is most convenient—while giving study teams new ways to maintain engagement throughout the trial.

Participant Burden Can Become a Retention Problem

The FDA defines decentralized clinical trials as trials in which some or all trial-related activities occur somewhere other than a traditional clinical trial site. These approaches can include telehealth visits, activities completed at home, visits with local healthcare providers, and remote data collection using digital health technologies.

For patients, that flexibility matters.

Research examining the challenges associated with traditional clinical trials has found that 29% of more than 12,000 respondents considered travel to and from study sites somewhat or very burdensome. A 2026 qualitative evidence synthesis similarly identified time away from work, childcare, travel, transportation, and associated costs among the burdens participants may face when attending follow-up appointments.

The FDA has specifically recognized the potential benefit of decentralization, noting that bringing trial activities closer to participants may reduce travel and improve engagement, recruitment, and retention, particularly for people who have difficulty accessing traditional research sites.

The goal isn't necessarily to eliminate the research site. Instead, a hybrid or decentralized approach can help teams determine which activities truly need to happen at a site and which can be completed more conveniently from home.

Making Participation Fit More Easily Into Everyday Life

Every unnecessary trip eliminated from a protocol represents time a participant gets back.

With a decentralized approach, activities such as electronic clinical outcome assessments (eCOA), questionnaires, electronic consent, telehealth visits, digital health technology data collection, and other study interactions can potentially happen remotely.

That can be particularly valuable for long-duration studies and studies involving participants with mobility limitations, chronic conditions, demanding treatment schedules, or significant caregiver involvement.

Published DCT research provides evidence of what this approach can look like in practice. One decentralized randomized controlled trial in Singapore reported 97% post-randomization participant retention. Researchers attributed the high retention, at least in part, to the decentralized design, including greater scheduling flexibility and eliminating travel time.

Importantly, decentralization alone doesn't guarantee retention. A recent review of decentralized trials found that some studies still experienced retention challenges. The technology and study design need to make participation easier—not simply replace an in-person burden with a digital one.

How THREAD Helps Reduce Participant Burden

THREAD's decentralized clinical trial platform is designed to give Sponsors and CROs the flexibility to create study experiences around the needs of participants while maintaining the controls required for clinical research.

1. Bring Study Activities to the Participant

THREAD's participant app enables research activities to extend beyond the traditional site, allowing participants to complete assigned activities from home, in the clinic, or on the go.

Study teams can configure participant workflows around the protocol rather than forcing every participant through the same site-centric experience. This can help reduce unnecessary travel while maintaining the appropriate combination of virtual, remote, and in-person interactions.

2. Make eCOA Easier to Complete

Electronic clinical outcome assessments can create another source of participant burden if they're difficult to access or require unfamiliar technology.

THREAD supports Bring Your Own Device (BYOD) and provisioned device models, giving studies greater flexibility in how assessments are delivered. Offline functionality can help maintain accessibility when connectivity is limited, while configurable workflows allow assessments to be presented when they are required by the protocol.

THREAD also supports deployment in more than 60 countries and over 100 languages, helping sponsors provide a more consistent experience across global studies.

3. Keep Participants on Track With Smart Reminders

Retention isn't always about a participant making an active decision to leave a study. Maintaining engagement also means helping people remember what they need to do and when they need to do it.

THREAD supports configurable reminders, notifications, and participant engagement tools that help participants stay aware of upcoming study activities and assessments. THREAD's eCOA capabilities specifically include smart reminders designed to improve compliance and active engagement tools that support retention.

Instead of relying entirely on manual site follow-up, study teams can build engagement directly into the participant experience.

4. Capture Data Through Wearables and Digital Health Technologies

Some endpoints don't have to depend on a participant traveling to a clinic—or even remembering to manually enter information.

THREAD can integrate data from wearable devices, sensors, and other digital health technologies, helping studies collect information remotely and more continuously where appropriate.

This can reduce the number of participant actions required while providing researchers with data reflecting patients' experiences outside the clinic. The FDA's final DCT guidance specifically addresses the use of digital health technologies for remotely acquiring trial data as part of decentralized study designs.

5. Maintain the Human Connection

Decentralization shouldn't mean disconnecting participants from the people running their study.

Telehealth and remote communication can give participants more convenient access to research teams without requiring every interaction to become an in-person appointment. That connection may itself support engagement.

In the decentralized trial that achieved 97% post-randomization retention, researchers noted that participants generally interacted with the same study-team contact for virtual visits, helping build familiarity and rapport throughout the study.

Technology works best when it makes human interaction easier—not when it removes it.

Use Data to Identify Retention Risks Earlier

A digital approach can also give research teams more opportunities to understand how participants are engaging with a study.

Rather than discovering a problem after a participant has already become disengaged, study teams can use study data to identify patterns such as missed assessments, declining compliance, or other signals that may warrant intervention.

There is emerging evidence supporting this type of targeted approach. The large decentralized COVID-RED trial enrolled 17,825 participants, with 80.4% remaining after six months. Researchers monitored retention and missing data throughout the study and used participant data to identify groups at greater risk of discontinuation so retention interventions could be targeted accordingly.

THREAD's configurable reporting, alerts, participant engagement capabilities, and integrated data approach can help study teams gain greater visibility into study activity and take action when intervention is needed.

Build Retention Into the Study From the Beginning

Patient retention shouldn't begin when a participant misses an assessment or fails to attend a visit.

It should begin with study design.

That means considering where participants will complete study activities, how often they need to travel, which activities can happen remotely, what technologies they'll need to use, how they'll receive reminders and support, and how quickly study teams can identify signs of disengagement.

The FDA has recognized that decentralized approaches can enhance convenience, reduce caregiver burden, expand access, and facilitate research involving rare diseases and populations with limited mobility.

By combining flexible study design with eCOA, telehealth, digital health technology integrations, automated engagement, and remote data collection, THREAD helps Sponsors and CROs create decentralized and hybrid clinical trials that fit more naturally into patients' lives.

Because improving retention isn't just about convincing patients to stay in a study.

It's about designing a study that makes it easier for them to stay.