How can decentralized clinical trials improve access for underrepresented

Decentralized clinical trials (DCTs) improve access for underrepresented populations by removing several geographic and logistical barriers that traditionally limit participation ^[1].

Logistics and Telemedicine Tools

By incorporating decentralized capabilities beyond remote consent, DCT programs reduce the burden of travel ^[2]. Key logistics and digital tools include:
* Telehealth and Video Visits: Synchronous videoconferencing allows researchers to communicate with participants, manage recruitment, handle informed consent, and conduct assessments remotely across all stages of research ^[3].
* Remote Testing and Home Delivery: Remote phlebotomy, device services, and oral medication delivery minimize the need for frequent physical visits to academic medical centers ^[4].

Community Partnerships in Rural and Low-Income Regions

Simply opening more trials is insufficient without addressing community receptivity, organizational capacity, and regional trust ^[5]. Co-created research models use engagement strategies to collaborate directly with local stakeholders and primary care settings ^[6]. These partnerships help tailor protocols to regional cultural landscapes, resolve potential barriers early, hire local clinical research staff, and ensure trial designs match community objectives ^[7]. Furthermore, engaging community-based organizations and patient advocacy groups helps build lasting inclusivity ^[8].

Evidence on Recruitment Diversity and Patient Retention

Data from a multiregional DCT program implementation at the Mayo Clinic demonstrated favorable trends in accruals among populations residing far from traditional research sites ^[9]. Specifically, the percentage of DCT participants living more than 120 miles from an academic medical center site increased from 18.9% in the first quarter of 2024 to 29.6% in the first quarter of 2025 ^[10]. Among those accrued:
* Rural Representation: Participants from rural locations accounted for 20.8% overall, increasing from 16.6% in early 2024 to 24.9% by early 2025 ^[11].
* Racial and Ethnic Diversity: Individuals from racial or ethnic underrepresented populations comprised 15.4% of total accruals, ranging from 12.5% to 17.4% over the evaluation period ^[12].

Would you also like to know what specific operational hurdles remain in scaling decentralized clinical trials?