Advancing technology design to support patient-centred experiences in decentralised clinical trials
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Date
2026-03-30
Authors
Gamble, Eoin
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Publisher
University College Cork
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Abstract
Decentralised clinical trials (DCTs) are medical trials in which some of the activities that traditionally take place in a face-to-face clinical setting are replaced with technology tools that allow for remote patient participation. Industry stakeholders and regulatory bodies often describe DCTs as patient-centred, highlighting their potential to enhance retention, adherence, and participation. However, the challenge of ensuring that technology meaningfully enhances a patient-centred experience calls for continued refinement.
This thesis investigates how technology can be designed to better support patient experiences in DCTs. By critically evaluating the assumption that DCTs are fundamentally supportive of the patient experience, the thesis employs empirical data and theoretical frameworks to create tools for improving future technology design through four complementary studies.
The first study in Chapter 3 presents a systematic scoping review of retention strategies in published clinical trials. The study frames retention strategies in terms of participant motivation, highlights effective approaches, and demonstrates the value of applying theoretical frameworks to guide technology design decisions. By applying behavioural and psychological theory Self-Determination Theory, these insights offer guidance for designing technology that better supports participant engagement and retention, such as tailoring experiences to individual needs, reinforcing competence, and supporting relational connection.
The second study in Chapter 4 uses qualitative interviews with 15 clinical research staff to explore perceptions of delivering a patient-centred experience in decentralised trials. Thematic analysis identified the limited quality and frequency of interactions with patients, alongside six related themes. While DCTs improve accessibility, they introduce complexities that can affect patient engagement and retention, highlighting the need for additional support, streamlined technology, and collaboration with staff and patients to enhance the patient-centred experience.
The third study in Chapter 5 uses qualitative interviews to explore the lived experiences of 14 individuals' participation on decentralised clinical trials, focusing on the challenges and opportunities of remote participation. Using a thematic analysis this study identified six main themes, including positive experiences with remote participation, co-ownership, and the hidden workload of participation. The findings highlight the need for technology that supports participants’ well-being and experience, and for collaboration with stakeholders to enhance engagement beyond basic remote access.
The final study in Chapter 6 builds on these findings by presenting a set of design cards to guide the design and ideation of patient-centred technology in DCTs. The cards were developed by synthesising insights from the preceding studies involving participants and trial staff, alongside relevant literature, and were evaluated through practitioner feedback following their use in workshop activities. This offers a novel approach and practical guidance grounded in a patient-centred care model, Self-Determination Theory, and empirical evidence from this research. They can be applied to inform the design of future DCT technology, supporting interventions that are more engaging and ultimately improving the patient experience. By
integrating insights from the previous studies, the cards provide actionable guidance for technology practitioners, translating evidence and theory into design decisions that enhance patient-centred experiences in DCTs.
Collectively, the four studies presented in this thesis investigate and help inform how technology can be designed to better support patient experiences in decentralised clinical trials, combining a systematic review, qualitative insights from staff and participants, and a practical design outcome. The research synthesises evidence from the literature, staff perspectives, and participant experiences to inform the creation of design cards, which provide guidance for developing patient-centred technology in DCTs. By integrating these complementary studies, the thesis offers a coherent foundation linking empirical findings, theoretical guidance, and design practice.
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Keywords
Patient experience , Human Computer Interaction
Citation
Gamble, E. 2026. Advancing technology design to support patient-centred experiences in decentralised clinical trials. PhD Thesis, University College Cork.