In this episode, Liam and Ted explore one of the most underexamined problems in clinical trial recruitment: patient motivation is not static.

Drawing on real-world experience from a late-night participant funnel audit to an insomnia study no-show Liam introduces two interconnected frameworks: the Decision Threshold Matrix and the Trial Value Equation.

The matrix maps patient motivation across four quadrants defined by disease severity and perceived treatment adequacy. It breaks down how patients unconsciously calculate whether participation is worth it and why trial teams consistently inflate the denominator (burden) without strengthening the numerator (benefit).

Together, these tools offer a behavioral science-grounded lens for understanding when, why, and how patients engage with research and what teams can do about it.

This episode is for anyone working in patient recruitment, site management, or protocol design.

In the final episode of our three-part series with Jill Fikowski, founder and CEO of Changemark Research + Evaluation, we get into one of the most persistent problems in clinical research: retention.

Jill unpacks why participants drop out and it's rarely what sponsors assume. From there, we get into the pressure that lands on research coordinators when enrollment is behind, the practices that pressure produces. We also look at what happens after the last visit particularly in psychedelic trials and whether researchers have a responsibility that doesn't end when the database closes.

Retention problems, Jill argues, are almost always inception problems. And solving them starts with a question most teams never ask.

Part 3 of 3.

In Part 2 of our conversation with Jill Fikowski, founder and CEO of Changemark Research + Evaluation, we get into what good community engagement actually looks like in practice not as a checkbox, but as a core design principle.

Jill opens with a clear answer to what good looks like: involve community from the very beginning and not just at the consent stage, not just in an advisory board email, but in protocol design, recruitment strategy, and how findings are shared.

Jill walks us through a Quebec youth cannabis and psychosis study that surpassed both its enrollment and retention targets simply by asking participants what they needed before the protocol was finalised.

We also get into the tension between industry-sponsored research and genuine community care.

Part 2 or 3