Leveraging Video for Clinical Trial Success - David Grew

This week, I'm joined by David gray, radiation oncologist and founder of primer, a platform

that creates simple illustrated videos to educate patients about cancer and clinical trials. David explains how video content can be leveraged to scale clinical trials, reducing patients suffering through improved patient engagement. David also discusses how video content can reduce physician burnout supporting better physician patient relations. David, welcome.

Let's start at the beginning. Could you explain more about your medical background and involvement in clinical trials? I'm a radiation oncologist, and I do practice in Hartford, Connecticut,

at a Yale affiliate Cancer Center. But I really started my journey with patient education back during Med school because I was kind of doing a side hustle, teaching undergraduates who were preparing to take the MCAT entrance exam for medical school.

And I was basically teaching at a whiteboard. So using simple visuals to explain complex concepts was really something I enjoyed. I had a passion for it, and I seemed to develop a talent for it, just spending probably about 1,000 hours standing at a whiteboard teaching kids. So over time, as I went into my own clinical practice, I sort of carried this experience of using visuals to explain these complex cancer problems to my own patients.

And during covid, in the early days, there were no visitor policies. So patients had to come alone to see their oncologist for the first time to discuss their new diagnosis of cancer. And I started taking my paper drawings and converting them into digital videos that were about two or three minutes. Just explaining what to expect about a new diagnosis of breast cancer, what the surgery options are, how radiation works, the way chemotherapy works, and these kinds of things which just like the common questions that we would get from our own patients, but we could send them to their families as a text message.

We could share them at infinite scale with no additional input costs from us. So it turned out to be a pretty valuable thing for my own patients. And one day, a clinical trial investigator who was a friend of mine noticed what we were doing and said this would be a huge help for us, for our trials, the really complex. It's difficult for our team to explain these trials over and over.

Could you start making content for our trials? And so that's when things really kind of started taking off in the clinical trial space. So you were discussing how during COVID you Drew out images to make them clearer for patients. How did this translate into you realizing that video was the way forward?

It's funny. One day a patient who was an older woman who again was there on her own, she my Secretary yelled down the Hall and said, hey, patient wants that paper drawing that you made for her. I wasn't thinking much of it because it was kind of a slapdash sketch on a piece of paper, but to the patient it was pretty useful. So she said she wanted to keep that little piece of paper with my sketch on it so that she could explain this

to her family because she was concerned and didn't feel confident explaining this whole process and a treatment without that prop.

That's when the light bulb went off. And I said, well, maybe I should just start converting these paper drawings into video assets so that we can kind of standardize this educational experience for our patients and introduce a lot more scale. Yes, it just shows how fast communication is changing, and how clinical trials can adapt to reflect this and the industry at a wider level. How do you believe modern methods of communication can lower the barrier to entry for trials?

So we're experimenting a lot with that. So we're starting with longer form videos, and by that I really mean like two or three minutes. So it's not that long. A 10 minute video based on our analytics is way too long.

You lose engagement after about two to three minutes. It really starts to go off a cliff. So the longest videos that we make

are two or three minutes, but we're exploring, doing even shorter versions of that, whether the sound is accelerated and we're just flashing images to catch patient's eyes about a trial or even going even shorter to like 4 to 6 seconds just as a GIF or a gif, however you prefer to pronounce it. So obviously there's no sound in that, but just using it a motion image to catch the eye of a patient or a patient advocate or a caretaker to just introduce the visual concept of a clinical trial for something that pertains to that particular patient.

So interesting you mention GIFs or GIFs there. However, people want to pronounce this word. So do you think that other kind of modern ways. Ways of communicating, especially among younger generations like memes and emojis.

Are they also communication ways of communicating that you are exploring or you'd like to explore? I would like to explore that because I know from my own patients, oftentimes the caretaker is the one who is really sort of facilitating most of the conversations and the referrals to subspecialty physicians. And certainly if there's going to be a referral to a clinical trial. Oftentimes it's the caretaker who is doing a lot of the background research in identifying these trials and getting things set up for the patients to meet with the doctors and stuff.

So who is that caretaker? Well, sometimes it's the spouse of an elderly patient, but oftentimes what we see is it's a much younger family member or just advocate for that patient who are much more accustomed to communicating in the shortest form possible, even in the form of gifts and memes and emojis. So we haven't gone all the way to emojis yet, but I think if we're trying to truly solve the problem of patient education and patient engagement, we do need to think about leveraging the most engaging forms of communication. And that includes what you just mentioned.

I can't wait to see how that develops. Now at tech route, we've seen how the impact of video can translate to higher study engagement. Could

you explain more about the benefits that physicians are experiencing with primer? We're seeing that patients are highly engaged with our educational content.

So in, for instance, our first trial that we launched with a clinical trial team at Cornell and the first month that we made the video available, there was 16 hours worth of patient view time. So and it's not a big trial. It's a single site study looking at a fairly unique question relating to MRI guided radiation therapy. So what can we learn from that?

That tells us that patients aren't just watching it once. They're either watching it multiple times themselves or they're sharing it with their family members, which makes total sense. Oftentimes, patients who are considering a trial are not making that decision in a vacuum. They're discussing it with their care team or their kids, their spouses, their siblings, their best friends.

And so naturally, in those conversations, the question comes up, well, how does the trial work? And what we create for the peers, the sponsors, the sites that we work with is a highly shareable digital asset that patients can share themselves. They can simply forward it as a text or an email to the rest of the people on their care team. So it just seems to be something that caught on very quickly and is definitely harnessing engagement at the patient level.

Anecdotally, we know that there is a patient who was living in Florida. And had somehow caught wind of the content that we had created and was willing to actually fly to New York to the site there to enroll on the study. So I think what video content can do, whether it's the long form we're doing in two to three minutes or the shortest format as gifts and really blasting it on social media channels is it's just amplifying awareness. And because content scales infinitely, you just never know whose eyeballs are going to see that content and who's going to engage with it and eventually lead back to the trial enrollment page.

And I continue to be surprised by anecdotal stories like that because when you're using social channels, the network is so wide. We need to start thinking very differently about how we're going to

recruit to trials. And I think video is an insanely powerful engine to amplify awareness, engagement and recruitment for trials. So you could expand a bit more on the specific benefits for physicians, e.g. burnout, et cetera I was just reading an article today saying that in the US physician burnout is reaching record highs.

I think 65% to 70% of practicing physicians are reporting symptoms of burnout. So if we look specifically at the clinical trial enrollment case, why would physicians burn out? Well, if patients who are trial eligible are coming to discuss a trial with a provider, that provider needs to go over the entire standard of care, just like. Any community physician would.

But then in addition to that, they need to go a layer deeper and explain what beyond standard of care, we also have this additional option in the form of a clinical trial. So that's a lot more of their time. It's hard to do that over and over when you're already double or triple booked in your clinic. And so you have two options.

You can either take the time, you know, that patient needs to explain the trial and just your clinic just starts getting pushed

back further and further. And that means you don't have time during the day to do your charting and dictating notes and things like that. And suddenly now you're not there till five, you're there till eight, you're not seeing your family. And you can kind of see how the frame shift, frame shift in your day, the hours of your day accumulates over time.

And that's a lot of time under tension for physicians, and that leads to burnout. What we're seeing is that we're kind of preloading the educational piece with primer is we're making it so that trial eligible patients are getting access to basic information about the trial before they meet with the provider. And that way, when they're having the in-person encounter, if it's a quick no, then that's fine. At least the provider doesn't need to waste time going over the entire trial information with them.

They can just stick with the standard of care operation that streamlines their clinic. However, if the patient's already interested in the trial now, what we're doing is we're actually serving these providers with motivated and engaged patients who are aware of the trial, understand it, and are interested in enrolling. You're kind of being much smarter about the way that the workflow is of serving the providers with engaged patients who are interested in trials, if that makes sense. And if we move to patients.

Now and specific feedback you've had from regarding the benefits of video, do you have any interesting anecdotes or feedback you can share? I do. So I have a patient who has prostate cancer and he is the caretaker for his elderly wife who has Alzheimer's. And she really needs 24 hour care.

Before we met, he wanted he needed some good educational content around what the prostate cancer options are in terms of radiation, and they vary greatly ranging from five days of radiation, up to nine weeks of radiation. So we used primer content to send to both him and his son, who's located

in a city six hours away. He could not join us for the consult, so the two of them received the primary education content before the visit and they were able to discuss how best to get the patient to a curative radiation treatment in the context of also being the primary caretaker for his wife who deals with Alzheimer's.

So in their words, what they said was they really appreciated preloading the education so that they really by the time he came in to see me in person, he and his son already were aware of the options. They kind of talked it through and they came highly engaged and ready to make a decision confidently about which treatment was for them. Also on the call we have the other day, you also talked about the pilot project with Columbia. So we're also doing a pilot project at Columbia University in New York, educating women who have been through breast cancer surgery and are at high risk for developing swelling in the arm, which is called lymphedema.

That condition, if untreated, can be really debilitating. However, there are certain exercises and certain things that women can do to detect the earliest signs of that condition. Lymphedema and present for referral

for lymphedema therapy that can potentially reduce the overall long term morbidity and the long term burden of that condition on patients if they get in early to get these kinds of interventions. So we believe and the team at Columbia agrees that early intervention with education may be useful in preventing some of the really debilitating long term effects of this.

So what we're doing with them the problem, though, is that the surgeons, the radiation oncologist, the care teams naturally are they're rushed in clinic. And so they don't have time to go over in great detail all of these exercises and all the things patients can do. So what we're doing in this pilot project is we're creating educational video content, which we're serving to the patients at various stages throughout the arc of the patient journey. So we have an introductory video that really just teaches patients about what lymphedema is, how it works, why it happens, and what puts them at risk for developing it.

And then later on in their care journey, we give them additional education on exercises and stretches. That they can do to prevent lymphedema. And then ultimately, once they're done with all of their treatment, they get an additional video content that explains to them if they see some of the early signs of lymphedema, what they need to do specifically at Columbia and New York Presbyterian, to present to the care team to get referred to get the therapy that they need. Now, with digital campaigns, we hear a lot about success metrics, time watched, et cetera.

How do you measure success with primer? So it really depends on the trial and what the vision and goals are for the trial. So in the pilot project I mentioned at Columbia, we would like to see more women recognizing the earliest signs of lymphedema and presenting for physical therapy and rehab measures. So we're trying to capture patients who need a treatment that they otherwise weren't getting because of a lack of education on a different trial, say, like a decentralized trial.

One of the challenges there is maintaining patient engagement throughout the entire trial. It would be a terrible waste of all of the participants time, the sponsors

money to go through an entire trial and have the majority of patients get lost to follow up. Degrading the quality of the data that we can harvest from the trial in the end because we can't keep them engaged throughout the entire arc of the trial. So success in that context looks a little different.

It actually looks more like making sure that x number or x of patients who enrolled on the trial initially actually stay engaged with the trial and complete all follow up measures throughout the entire arc of the trial. And we're trying to use content to kind of pepper them with nuggets of engagement throughout the entire trial. Now, with any new ways of communication,

there are always obstacles. What challenges have you experienced with video.

So far and how have you overcome them? I think that's a great observation and we have experienced some challenges. So there's a generation gap and depending on age and patient's willingness to engage with technology, you are going to find some patients just have a preference against technology and digital engagement.

Their bias is in favor of just face to face conversations with their doctor, and there's nothing wrong with that.

We still need to serve them with that sort of option and and engagement. So this solution with video is probably not going to penetrate that group of patients in an effective way. So I think what we're ultimately going to see is a very successfully run trial is going to have sort of a tapestry of strategies where you're layering in multiple, multiple layers of education and engagement. Some of it is in person.

Some of it may continue to be paper, although I think that's kind of going by the wayside. But certainly I think there's a good role for video and digital education. I think another challenge is so we have the content, we have analytics suggesting that it's highly engaging. The question is how to serve it to them.

And when to serve it to them. So that's something we really need to test. Is it best before that first visit? Is it best on their way out to the parking lot after they've completed the first visit?

And then at what time points throughout the arc of the trial is it most engaging to serve patients. And participants with content later on? So we're looking for partners at DCT platforms, sponsors that do clinical trials at scale, innovative peers who are willing to partner with us to test these various things so that we can really maximally leverage this form of education to complete more trials. The whole name of the game here is to accelerate innovation.

And one of the things that can frustrate and slow down innovation is incomplete trials, slow accrual and loss to follow up. So we're trying to help pis, sponsors and sites move the needle on that by delivering better engagement with education. What is your opinion on how video content can support decentralized clinical trials? Because decentralized trials offer a more convenient option, patients just are a bit untethered from the health system.

There's a lot of advantages from that. I mean, they have jobs. They don't want to spend hours and hours driving to big cities, parking all the additional expenses that they accrue by just participating in the trial. But the downside is that they're untethered, so you need to find innovative ways to keep them engaged.

And so we're in initial talks with some platforms to start experimenting. By leveraging this very sort of bespoke content that's for that trial. And so I'm pretty excited. I'm extremely optimistic about the future of integrating with sites and just having a lot of fun talking with platforms about coming up with innovative ways to integrate this kind of content into their platforms.

And finally, what's next for primer in terms of initiatives and goals? So we're really still in an Explorer mode. We're still working with a variety of partners ranging from PC sites, sponsors and platforms. We're not limited in any way in terms of who we're willing to work with.

We're we're just trying to add value by improving education. So in the fourth quarter, we're hoping to nail down some solid partnerships with each of the players that I mentioned. And I would encourage your listeners if there's anyone who thinks this could add value to their trial, to reach out and see if we might be able to partner on a project. And David, where can people find you?

I'm very active on LinkedIn and I would encourage people to just go ahead and DM me there. But you can also email me and it's, it's just my name. David group r W at primer medcom and Primus primer Mead. You can find us our landing pages.

Primer medcom. I'm also on Twitter Dr.