Patient-Related Issues

Reimbursement for clinical trial participation: Useful recruitment strategy or unethical practice?

Last Updated: Oct 28, 2013

Do you think reimbursements motivate people to participate in clinical trials?

Linda Parreco's Image

Offering monetary reimbursement to trial participants contributes to successful recruitment and retention. Investigators planning reimbursement have to balance these benefits with ethical concerns such as coercion and undue influence. One has to carefully consider the appropriate amount, form (e.g., cash, check, gift card), and timing (e.g., before, during, or after the study) of compensation. Financial constraints are also an important factor to consider, as even a $2 per patient compensation can significantly cut into the trial budget in the case of large trials.

In a recent article featured on AccrualNet, Breitkopf et al. argue that a better understanding of how clinical research participants perceive financial incentives may help maximize clinical trial recruitment, enhance retention, and maintain scientific integrity. The researchers queried participants of a Phase I clinical trial about their perceptions regarding reimbursement. Most stated that reimbursement is unlikely to be coercive. Interestingly, some thought that the reimbursement amount matches or should match the level of risk. Published guidelines stipulate that no payment should be given for assumption of risk. It is therefore concerning that some patients may perceive studies that offer little or no reimbursement as being low risk.

Do you think reimbursements motivate people to participate in clinical trials? What are your main concerns regarding reimbursement in clinical trials? Have you heard any reactions from participants who have been offered reimbursement?

SStennett's Image

I definitely think that reimbursements will motivate individuals to participate in clinical trials, especially when targeting a population that may potentially still be in the work force. We are asking for subjects to sacrifice their time, potential loss in work pay, and travel to the research center. However, I am concerned with clinical trials with unusually high reimbursement, especially if the trial is high risk. That can be unduly coercive. Most of my research subjects would participate whether or not they were reimbursed, but they definitely appreciate the compensation.

Linda Parreco's Image

Thanks for your comments! Your concern that high reimbursement rates, particulary for clinical trials where the participant assumes higher risk is certainly valid. One of the interesting aspects of the Breitkopf et. al paper was that many women in this study believed that if a participant assumes higher risk, they should receive higher compensation. According to the paper's authors, these findings should provide strong encouragement for investigators to engage in careful thought and planning regarding reimbursement amounts. 

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