Patient Travel Solutions: Easing the Journey to Clinical Research Sites

According to the Center for Information and Study on Clinical Research Participation (CISCRP), traveling to a clinical study is the top reason trial participation is disruptive for patients. Learn more about the complexities of patient travel in clinical trials and what the industry is doing about it with Chris Benevides, Director of Patient Travel Services at Elligo Health Research®. Chris offers valuable insights on early planning, risk mitigation, and specialized travel services that can set up sites for success. Discover how travel support can improve patient recruitment and retention, making clinical trials more diverse, accessible, and patient-friendly. 

Transcript

Jimmy Bechtel: 0:02

Welcome to SCRS Talks, provided by the Society for Clinical Research Sites. Thanks for joining us as we explore the latest insights, trends, and innovation shaping clinical research today. I'm Jimmy Bechtel, the Vice President of Site Engagement with the Society. Today, I'm joined by Chris Benevides, the Director of Patient Travel Services with Elligo Health Research, here to talk with us a little bit about patient travel burdens and some of the challenges and solutions that we see when it comes to getting patients to a clinical research site in an effective and safe manner. Chris, awesome to have you. I'm really excited to talk about this subject because we know that patient travel burdens continue to be an issue at the site level. And kind of is one of those things that you almost don't even realize the challenges that exist here until it comes time to trying to arrange travel for patients who might need assistance there. So I'm again, really excited to talk about this. But before we jump in, I'd love to learn a little bit more about you and your background and maybe a little bit about Elligo Health.

Chris Benevides: 1:05

Yeah, sure. Thank you, Jimmy. I appreciate it. And of course, you know, appreciate the opportunity to join you and discuss this topic. Yeah, I would agree. It's certainly one that, you know, kind of flies under the radar until it's I would say last minute needed. And then all of a sudden, everyone sort of scrambles to get included, you know, within their budgets and proposals. And I'm so excited to talk to you about you know, ways that we can make this a little bit more on the forefront of sponsors, minds and, keep sites sort of engaged as to what resources they have available from study to study. For me personally, my name again is Chris Benevides. I am the director of patient travel at Elligo. I've been with the company for about five years or so. I've been director in this department now for roughly two years but have worked within patient services for quite a while. And currently, I'd say probably have a tenure of about 100 plus clinical trials working in patient travel at the moment. So you know, have some experience with how to navigate this and work with sponsors and sites and of course the patients that are taking advantage of our services and just try to find ways to make them more comfortable in their journeys and expand this service to more patients that otherwise would need that to get to and from their site visits. So that's a bit about my background and excited to dive in further.

Jimmy Bechtel: 2:13

That's great. Thanks, Chris. And I kind of want to set the stage here for everyone and talk about, you know, really the issue at hand. And we know and have seen recent CISCRP report that noted having to travel to a study clinic to where clinical trials are occurring is arguably the most disruptive part of trial participation from that patient perspective. So, how do these barriers really impact underrepresented or low income populations specifically who might have adversity when it comes to travel and their ability to participate in these clinical trials?

Chris Benevides: 2:48

Yeah, it's a great question. I'll kind of break it into two parts if we could. Elligo actually did a survey about two years ago and we basically conducted a questionnaire related to this exact sort of question around patient travel. And we ended up surveying about 500 patients within various clinical trials that we were working on at the time. And an interesting fact came out from that, where 55 percent of respondents and patients stated that the physical location of the site would have been a barrier to enrollment, if not for the travel services. So, I would say the first piece that really kind of needs to be highlighted, especially if you are considering or including travel within your clinical trial is that, it's hard enough to find the right types of patients, right? In general, we understand that we're trying to open up and broaden the spectrum for people to have access to clinical trial, especially if it's health care as an option for them. And so when you're considering what that might look like, you're basically stating that one in two patients who you find as being eligible for your trial are considering not joining that trial specifically because of a physical barrier with getting to the site. Right? And so it's actually kind of mind boggling with how much resource goes into finding the right types of patients. And then, considering that less than 50 percent of them are actually going to join. So, that's essentially why Elligo and I would say most of the travel companies in the industry exists to simply remove that barrier. And so then, when you take it a step further for low income patients and folks that, again, need clinical trials, especially as a health care option they're facing additional burdens that most people do not. So, it could be something as simple as only having one car for the family to use. You know, it's hard enough to reschedule your whole day. And if you only have one car and someone has to go to work, someone has to stay home, you know, with children, especially if they have multiple children, all of a sudden that becomes a very difficult way to rationalize. Okay. Well, even if this was a good opportunity for myself, or say, if it's a pediatric study, for example, I can't even figure out how to get there. And so when you look at kind of the surrounding dynamics of what these types of patients have to think about on a day to day basis, having travel covered as part of the option to get them to their site visits is incredibly important, right? And again, this is just one element. I mean, you can go down to, financial burdens and, you know, for example, I have a newborn son, he's five months old and he actually was diagnosed with a dysplastic kidney. Now we're not in a clinical trial, but the idea of even working with my wife as to how we're going to take work off and getting to his nephrology appointments, that in and of itself becomes quite difficult to manage. And I can only imagine having to manage that on top of other considerations if a clinical trial comes up, you know, it's like, do we join this? Do we not? How are we going to get there? Do we have the funds to get there? You know, if it's a rare disease, are we flying halfway across the country and what does that mean? Do we have to take work off? Do we not? You know, so there are just so many different components and questions that each family has the weigh where if a clinical trial has this set up for patients, it becomes one less question that patients have to worry about. And so again specifically for those lower income families where finances and means to get to and from clinical trials becomes an even more important factor with their decision making.

Jimmy Bechtel: 6:19

I couldn't agree more, Chris. And the examples that you gave are good ones and there's countless others, right? I mean, every single circumstance, which is probably where some of the challenge with patient travel exists. Is that every single circumstance is gonna potentially need a different solution and different timing and you add the complication of some of the restrictions that we have around the clinical trial process on top of, you know, some of the examples that you personally gave. And it becomes a very complicated, convoluted process when there isn't necessarily a blanket solution that you can just apply across all the patients and all the clinical trials, you kind of have to look at things on a case by case basis, because as we both stated, the potential challenges are numerous.

Chris Benevides: 7:04

100 percent agree. Yeah. And we can even talk a little bit further about that as to solutions that sponsors should be thinking about. But I'll let you continue with your questions. We'll probably back into that.

Jimmy Bechtel: 7:13

Yeah, we'll, we'll definitely get there, which is, is kind of a little bit of where I did want to head with my next question. Sponsors typically have had limited ability and power to address the burden beyond just covering costs or reducing those visits. A lot of patients that solve some of the problems, some of the situations as we've coined them but it doesn't solve all of them, or it might even not solve a majority of them. So what can we as an industry do then to start to reduce some of these burdens and address some of those specific scenarios that you had mentioned?

Chris Benevides: 7:44

I would say first and foremost, if I would have bubble up that question, one thing I would know is that it is really, really encouraging to see the different travel options now that sponsors have in front of them. So, obviously Elligo is one of maybe five or six travel companies basically that have this capability. So as a general sort of, market analysis of where there is a need, someone will fill it, it's been really good to see that the need has been identified, especially in the last decade or so. And companies are now filling it with at least a very good solution for the most part, right? Again, travel, as I'm sure many people know, just in a general sense is not always perfect. And so it's really good to have it make sure you have a team that knows what they're doing. But generally speaking, there are a lot of competent companies out there that can handle the various needs that patients face on a day to day basis. So I would say that, from a high level that's a really good sign for the industry. And then when you kind of simmer that down further, there are a lot of considerations. And again, everything is depending on what that protocol looks like. What is the clinical trial study schedule? What is the indication? What does the patient journey ultimately look like? All of that really needs to be factored into the way that the travel program is developed. And so my advice is when you're working with a company, make sure that they're really thinking about the risk mitigation plan when they're developing either their presentation to you before you select them or even post the selection process. And so, you know, for example, the Elligo team does a heck of a lot of work at the forefront, before the onboarding process takes place with sites. We work through a project plan with all of our clients and really kind of map out what are all of the things that could potentially go wrong in this travel journey for a patient, right? It doesn't have to be all of them, but just in the event something happens and what are we going to do about it, right? What is the plan if flights get rescheduled or there's a storm in New England and you have to renegotiate the flight itinerary for that patient who might be traveling from Georgia, for example? There are a lot of things that are not thought of at the time of the selection process happening. And sponsors, again, they're doing a hundred different things and so they're probably not thinking of those minute details. So, to boil that down, it's important to have an expert team working on your behalf, making sure that they are thinking of all the things that you are not.

Jimmy Bechtel: 10:00

It's exactly right. It's one of those situations where you kind of don't know until you don't know. And not everyone is an expert in the travel nuance and these challenges that exist and just having those people in the corner. And I agree that risk mitigation, that sort of insurance, the protection that you can gain from helping and working with organizations like these from the site perspective is tremendous. Because they don't necessarily need to be the ones that are trying to mitigate those challenges for the patient. So having this service in place that can help expedite and be experts in the execution of that patient coming to the site and mitigating any of the various challenges that exist, especially when we talk about these large scale kind of global trials where there's a handful of sites across the planet that are doing really important work. We hear all the time about patients traveling cross country for their clinical trial participation. It's invaluable to have someone in your corner helping you with that. So Chris, how is then Elligo specifically supporting the participation travel, coordination, and reimbursement. We've laid the scene here and talked about some of the problems and what can be done. And so then what is Elligo's role in being one of these organizations that serves as that expertise and as that resource for the trial and for the sites?

Chris Benevides: 11:14

Yeah. So I would say first and foremost you know, Elligo actually does a lot of different things as a general company. One part of the company is kind of like an SMO where we actually have a site network we're very familiar with how sites operate. We have basically about a 90 or so site site team throughout the United States. And so, whenever we work with sponsors and we talk through, especially on the travel side, what are the considerations that need to be made for travel? We obviously, of course, put the patient's journey at the forefront of how we map out whatever travel project plan we're putting together, but we also have considerations with how sites operate, what they need to be considered, the types of training that we put them through to make sure that we're servicing patients through the site, because they're going to be the ones on the front lines working with patients on a day to day basis. So I would say, Elligo comes with a unique level of expertise not just within the travel side of things, but also on the site side of things. So, so see that that's probably something that I think stands out as a different kind of variable or a unique sort of value add when working with our team. And then, I would say finally, the point of that question is the travel team itself. You know, we have a very strong travel agency. Every single one of our agents that works for Elligo has worked in the clinical trial space for, I would say upwards of 15 to 20 years at minimum. So, you know, we have a very established team. They've seen a lot of different challenges. And so, you know, you always kind of think everyone can sort of sail the boat in calm waters, but who can sail the boat in a storm? And I would say, you know, again, one of the key factors that makes Elligo a unique partner specifically to travel is what happens when things go wrong, and how are you going to mitigate those risks? And I think that that has been something as I've watched this team grow over the past 3 to 4 years they do such an extremely good and diligent job making sure all the detail has been outlined.And that way at the end of the day, the patient feels like they have an ally in their corner and makes that journey much more suitable and comforting and like they have a team backing them up not just in respect to their clinical trial, all of the medical pieces, but also from a travel standpoint. We get pieces of feedback from patients and sites all the time. And it's really encouraging to hear of the good work that our team continues to do. But what was interesting about two weeks ago, we got a patient update and it was kind of funny that they almost bucketed Elligo as being part of the sponsor, almost like we were an arm or like an appendage to the sponsor. They really started off the compliment with thanking the sponsor for everything that they're doing and Elligo being an extension of that sponsor. And so what I found unique in that sentiment was, these patients, sometimes it's hard to differentiate how does Elligo or any company for that matter, that's doing patient services, how do they differentiate themselves from the sponsor? And the patient side that actually is not really their concern and they just kind of see everything as one program. Whenever Eligo gets in place to work with clinical trials, our focus is of course, to really put the patient at the center of that journey and act on behalf of the clinical trial and the sponsor as best as we can. So in any case, not to belabor the specifics on what we do, you know, obviously we have a concierge level service, white glove from air, car, hotel, you know, we offer 24 seven support. I do think that that's a little bit of what the market has come to expect when engaging with the travel program, I know, you know, having haven't spoken to my peers and in different organizations and companies, a lot of us kind of do that level of work. And so, you know, at that point, the sponsor kind of has their pick of the litter for who they should pick as far as who can best suit and create the best travel program. So again bubbling that all up, it's really encouraging to see this service make its way into the industry at such a mature rate.

Jimmy Bechtel: 14:59

Well, absolutely. And as trials continue to become more and more complicated and we potentially are reducing and I guess we'll say revisiting the the site makeup and mix and just how we're delivering trials has become so different. I can see the value that a service like this continues to have for the industry. It really is valuable and I would like to give kudos or appreciation for the site and patient focus, right? It's not just about delivering a service for the sponsor so they can get the data that they need, but it really is trying to enable sites and patients to do what they need to do and be kind of ingrained in that clinical trial execution process on behalf of those patients. So that's fantastic. So Chris, I want to kind of begin to wrap us up here with my final question. Do you have any tips or kind of best practices for sites to ensure that these travel costs when necessary are funded in trial budgets?

Chris Benevides: 15:51

Yeah, I would say two things, and actually I'll address it kind of differently. I want to talk about the

15:56

sponsor piece first, and then

Chris Benevides: 15:57

I'll work into the site part of it. For sponsors, and again, I might just be preaching to the choir here. And I think most people know this who are working at either sponsors or CROs. But, you know, again, just consider the patient journey, and if you think travel is going to be an important piece of it, I always recommend trying to include it as early in the process of the project plan as possible. And so that way, you know, the budget is secured and that again, the considerations for why patients might drop out retention items are basically taken care of at the forefront of the project plan in and of itself. So that's probably the first piece I would say. The second piece for sites specifically, and this is something that I think is important. We have found that even when, for example, Elligo is a part of a clinical trial, and I'd wonder if this is the case for others, sometimes the sites tend to forget, right? They don't actually always know what the amenities are or what are the services available for patients. And so, one of the things that Elligo does is we try to remind sites, we encourage, and we train them up on what travel services are available. It is really incumbent upon the site, the site coordinators or, the people that are working at the sites to make sure you're communicating that to the patients, right? They need to know what is available to them in terms of services, whether it's travel or reimbursements or whatever it might be, if it's a gift card that's being provided or whatever, right? It could be anything, depending on how the clinical trial is set up, but that level of communication really needs to make sure it doesn't fall by the wayside. And, oftentimes, I shouldn't say oftentimes, but we do have tendencies to have to remind sites that, hey, you know, your sites are not taking advantage of this. Do they even know about it? And sometimes they're like, Oh, shoot, you know, we got to remind them that they can get reimbursed and they should be getting a stipend. And they, do you have black car travel available if they live, you know, within a proximity of, of what that site is. And so I think that's probably the biggest key is that when those services are available, make sure that patients are aware of it.

Jimmy Bechtel: 17:56

That's great, Chris. And it's part of building it into your processes. You know, just as you, you kind of execute and you look through the details of the protocol and you say, okay, at these different visits, I'm going to have to do this. And you're building your source and you're doing all these things. This should be ingrained in that process as well. And I get that. It's just like, I'm sure you do. It's sometimes it's a departure because this isn't something that we're going to have for every single trial, every single time. And it's probably going to look different for, for different trials. So analyzing that and including it in part of what you're doing to execute that clinical trial and have those conversations with patients and it just being, you know, another step in the onboarding is a great tip and I think a great place for us to end our conversation. It's been awesome to talk with you about this. Chris, I appreciate your insights here again. I think this is a growing area of clinical trials as we continue to remove and reduce the burden on patients to be able to get to the research site or to wherever they need to go to conduct their research visits. So thanks again for sharing. And it was great having you.

Chris Benevides: 18:55

Thanks, Jimmy. Really appreciate the opportunity and hope to connect with more people in the industry to talk through this further. And again, it's all about the practice and execution and making sure that patients are getting what they need in their clinical trial journey. So again, appreciate your efforts and exposing this and making this more at the forefront of what patients need.

Jimmy Bechtel: 19:14

Absolutely. I couldn't agree more. And for everyone listening we want to make sure that you don't forget to explore other site focused resources made available to you, like the various publications and webinar opportunities on our website, myscrs. org, where you'll also find a wealth of content and details about our upcoming engagement opportunities, like our Site Solution Summits being held throughout the calendar year. Thanks again for listening and tuning in and until next time.