Increasing Cross-Referral and Recruitment to Clinical Trials: A New Approach
Authors: Ristuccia Roslyn , Badoux Xavier C , Gibson Melinda , Huseincehajic Admir , Trotman Judith 
Published: October 2019

Abstract
Background/Aims
The Haematology Clinical Research Network of New South Wales & the Australian Capital Territory (HCRN NSW/ACT) comprises public hospital clinical trial unit managers committed to collaboration in the clinical research endeavour. In June 2013 we launched the ClinTrial Refer Application (App) on iTunes and Google play. This smart-phone and iPAD/Tablet tool provided clinicians, research staff and patients with instant knowledge of currently recruiting local haematology trials. It was associated with an immediate increase in inter-hospital cross referrals of patients to trials. Following this, the HCRN aimed to sustain and measure this increased referral and trials recruitment and to create a not-for-profit 'template App' that could be transferrable to other clinical trial portfolios.
Methods
Patient cross-referral patterns, recruitment and staffing data were obtained from each of the 18 contributing hospitals in the HCRN from June 2013 to June 2015 and compared with prior to June 2013. Google analytics for the App were downloaded. We worked with research staff of other cancer networks to create modified versions of the App, establishing search functions unique to each network's geography and/or tumour stream. Newly derived Apps had to conform to the specifications of ClinTrial Refer, namely being publically available and free to download, simple to use and hosting only publically listed data of currently recruiting trials.
Results
Within the HCRN there has been a sustained increase in cross referrals for clinical trials (median 1/month (range 0-6) to 9/month (0-18)) (Figure 1) and a state-wide >50% increase in recruitment from 300 to 460 from 2012 to 2014 and a 20% increase in unit staffing from 2013 to 2014. Google analytics usage metrics identify 3362 App users, over 24,703 sessions lasting an average 56 seconds. 19,907 of these sessions are in NSW where 91% of users are repeat users.
Ten other state and national haematology or other tumour stream ClinTrial Refer Apps have been derived from the original App, from Sept 2013 to July 2015 (Figure 2). While maintaining the basic structure of an easy-to-navigate listing of currently recruiting trials, each new App has been re-designed to ensure relevance for the needs of each network. This ranged from a simple re-configuration of the logo, splash screen and recruiting locations for other Australian haematology Apps, to providing mutational status options for melanoma trials or age criteria for paediatric and adolescent- young adult Networks. The back-end database of listed trials, selection criteria and recruiting sites can be rapidly easily updated by local trial unit managers ensuring currency of trial information (est. 30 minutes/month in total). The "early adopters" within other cancer research networks have reported a similar upswing in trials recruitment and Google analytics for these newer Apps are similarly impressive. Recognising ClinTrial Refer as an effective tool for patients to identify recruiting trials close to home, cancer consumer groups have posted the Apps on their websites.
Conclusions
An instantly accessible, simple smartphone Application has provided better knowledge management of local clinical trials across the spectrum of rare haematologic malignancies. A tool to facilitate collaboration in clinical research, it has significantly enhanced cross-referral and recruitment rates, increasing patient access to emerging therapies and supporting the viability of haematology clinical trial units across Australia. ClinTrial Refer has been rapidly adapted to suit the trials portfolios of other clinical trial networks, both within and beyond cancer.
Figure 1. Figure 1. Figure 2. Figure 2.

Disclosures
No relevant conflicts of interest to declare.