Why patient-centricity depends on site-centricity in clinical trials

We often talk about patient-centricity in clinical trials. But in practice, patient experience is shaped by the people delivering the trial: the site teams.

That’s why patient-centricity depends on site-centricity – designing trials around the realities of sites, so they can better support the patients in their care. This isn’t a new idea, but it’s becoming harder to ignore. Our most recent report The Site Factor, and discussions at the recent Society for Clinical Research Sites’ (SCRS) summit, point to a clear theme: if we want to improve patient experience, we need to start by enabling sites.

The Participation Equation showed that participant experience and trial completion rates are closely associated with perceived support from site staff. When sites are supported, patients feel it. When they’re stretched, patients feel that too.

And yet, across feasibility, training, and recruitment, the same pattern emerges; we’re asking sites to deliver more, without always designing trials in a way that supports them.

So where is the friction, and what would a more site-centric approach look like in practice?

Feasibility assessments need to go both ways

As trials become more complex, we need to ask ourselves whether we are designing protocols that sites can realistically deliver.

The 2026 European Site Landscape Survey recently presented by SCRS at the European Site Solutions Summit (2–3 March 2026) found that 59% of sites identify protocol complexity as the main reason for declining trial opportunities. When sites are excluded, so are the patients who rely on them. And even when sites do participate, protocol complexity remains a daily challenge.

This is not just down to the science – there are operational strains too, from scheduling visits to coordinating sample logistics.

A site-centric approach means treating feasibility as a two-way conversation. High-performing sites understand what works in practice and should have the opportunity to add meaningfully to protocol design and delivery.

The T word

Ask site staff about training, and they’ll tell you it’s not working.

Findings from The Site Factor show us that one size does not fit all. Teams want more flexible, relevant approaches, from on-demand modules to mentoring and peer learning. As expectations evolve, traditional training models are struggling to keep up.

And in this age of personalisation, it’s not just the format, but the content too. Different roles and levels of experience need different things. Those at the patient interface need training that reflects the realities they face day to day.

Initiatives like Cut>25 are a step forward, reducing unnecessary burden and freeing up time for patient interactions. But this isn’t about cutting for the sake of it. In fact, findings from The Site Factor told us that 86% of site staff want more training in communication skills, such as cultural sensitivity – capabilities that are critical to building trust with participants.

A site-centric approach means focusing on what staff actually need: removing the redundant and investing in the training that makes a difference.

Rethinking recruitment and engagement

Lack of patient awareness remains a major barrier to enrolment, cited by 1 in 4 respondents in The Site Factor. After months (or years!) spent designing trials, this represents a significant missed opportunity.

But clear, patient-facing materials can make a real difference to recruitment and retention. Yet many sites still find themselves creating these resources from scratch rather than being equipped with them from the outset.

More broadly, recruitment continues to be one of the biggest pressures facing sites, often without the level of support needed to address it effectively.

A site-centric approach means involving sites more directly in participant engagement. After all, they are best placed to:

• connect with local communities and referral networks
• shape a seamless journey from awareness to enrolment
• support patients beyond the protocol, from managing side effects to maintaining motivation

Sites understand their patients and local ecosystems. If we want to improve recruitment, we need to equip and empower them to lead it.

So, what does all this mean?

One of the clearest messages from The Site Factor was that site staff want greater recognition and appreciation for their role. Put simply, we need to treat sites as equal partners in clinical research – involving them early and involving them often.

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