Changing patient preferences toward better trial recruitment: an ethical analysis

Pepijn Al* (Corresponding Author), Spencer Phillips Hey, Charles Weijer, Katie Gillies, Nicola McCleary, Mei-Lin Yee, Juliette Inglis, Justin Presseau, Jamie C Brehaut

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


While randomized controlled trials are essential to health research, many of these trials fail to recruit enough participants. Approaching recruitment through the lens of behavioral science can help trialists to understand influences on the decision to participate and use them to increase recruitment. Although this approach is promising, the use of behavioral influences during recruitment is in tension with the ethical principle of respect for persons, as at least some of these influences could be used to manipulate potential participants. In this paper, we examine this tension by discussing two types of behavioral influences: one example involves physician recommendations, and the other involves framing of information to exploit cognitive biases. We argue that despite the apparent tension with ethical principles, influencing trial participants through behavior change strategies can be ethically acceptable. However, we argue that trialists have a positive obligation to analyze their recruitment strategies for behavioral influences and disclose these upfront to the research ethics committee. But we also acknowledge that since neither trialists nor ethics committees are presently well equipped to perform these analyses, additional resources and guidance are needed. We close by outlining a path toward the development of such guidance.
Original languageEnglish
Article number233
Number of pages7
Early online date28 Mar 2023
Publication statusPublished - 28 Mar 2023

Bibliographical note

We thank Luke Gelinas, who participated in our group’s discussions, for his insightful and helpful comments.
This work was supported by a project grant from the Canadian Institutes of Health Research (CIHR) (reference number: PJT – 169055).


  • Randomized controlled trial
  • Recruitment
  • Behavior change techniques
  • Research ethics
  • Autonomy
  • Manipulation


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