When 'No' Is a Good Outcome: Redefining Success in Cancer Research
At the core of any healthcare or science degree, students learn the importance of numbers. Specifically, “bigger” is often synonymous with “success”. It has been viscerally etched into my brain since my undergraduate Psychology 'Research Methods and Statistics' courses: a larger sample size, meaning more individuals enrolled in a study, increases statistical power and overall confidence in the findings.
Now, as a clinical research coordinator leading participant recruitment for lifestyle medicine studies across the cancer care continuum, I see how directly these classroom concepts translate into tangible practice. Indeed, scientists must adhere to strict frameworks and enrolment calculations to publish high-quality manuscripts (in-depth reports of their research and findings for publication in scientific journals). Notably, those manuscripts often display sample sizes as neat diagrams highlighting which participants have enrolled, declined, and withdrawn. The design is concise and skimmable, as any scientific paper aims to be.
Yet, once I started working in the field, I quickly realised that formal publications rarely capture what happens before a participant is enrolled. Now, being in the thick of it as a researcher, I have been exposed to this antecedent, and was shocked to encounter a whirlwind of human emotion and connection hidden underneath these numbers.
Inspired by this very dissonance, the purpose of this article is to shed light on the unique position that the recruiter occupies, carefully navigating between hard science and empathetic patient care, particularly through the lens of cancer research.
When I began working in the field, some days it felt like 100 phone calls might lead to just 10 conversations and, if lucky, a single enrolment. My head was spinning with numbers. Conversion rates. Percentages of this, total sums of that. Mind you, maths was my worst subject growing up. I was caught up in the logistics. Couldn’t make sense of the no's. My perspective was firmly rooted in the benefits of the lifestyle medicine interventions we offered to participants. I studied this science intently and practised it in my own life. The numbers should have been higher…
The numbers?
How could I let myself get so carried away with this thought?
My stomach twisted as I confronted the unfiltered, sincere truth palpitating underneath these figures. Every number on the recruitment list represents a person somewhere along the cancer care continuum. A child with a new rare diagnosis. A mother navigating insurance approvals to afford a harsh chemotherapy drug. An older patient learning that they only have palliative options left. Real people going through indescribable hardships.
Now, I did not suddenly realise the people I was calling were living with cancer; what changed was how I mentally organised my work. Sheepishly, I admit that somewhere in the midst of recruitment trackers, eligibility criteria, and enrolment targets, the people and the numbers had quietly become quite distinct categories in my mind.
The lesson was not that the numbers represented people. Paradoxically, it was that they had always been the same thing.
Seeing this clearly now, my role began to feel different. Indeed, researchers need participants to answer important scientific questions, and recruitment targets are imperative to uphold high-quality publication standards. Yet patients are not simply contributors to a sample size. By the time we contact them, they may be weighing their treatment options, navigating financial concerns, or simply trying to make it through another day of appointments. My responsibility, then, was not simply to execute enrolment targets and go through monotone, administrative motions. I realised it was much more nuanced: it was my duty to meet people where they were, answer their questions clearly, and help them make an informed decision during one of the most vulnerable periods of their lives.
To a notable extent, I feel that embracing this mindset has made me a better recruiter in my day-to-day. I have become less preoccupied with convincing and more focused on listening. For instance, instead of viewing potential hesitation as a barrier to overcome, I now treat it as an invitation to understand what matters most to the person on the other end of the phone. Sometimes, that conversation ends with enrolment. Other times, it ends with a respectful decline.
In fact, I remember spending close to an hour answering questions from someone who ultimately decided not to participate. It was like an intense ping-pong match; he shot rapid-fire consecutive questions at me, and I quickly adapted by returning this imaginary ball with clear and concise explanations. The intern shadowing me that day must have been turning her head back and forth. When I hung up, I had technically failed to enrol. Yet it did not feel like failure.
With another individual, I spent several follow-up calls answering similar questions, reviewing study expectations, and ensuring that we could find a creative way to work around her busy schedule. After careful consideration, she was excited to participate and brag to her friends that she was contributing to research. Looking at it, both outcomes could represent success if the individual felt empowered to make the decision that was right for them.
This perspective has impacted the way I think about the metrics that define success in research. Enrolment numbers will always matter. Of course! They are the foundation of rigorous science and the crucial discoveries that follow. Nevertheless, they tell only part of the story. They cannot capture the patient who finally felt confident asking difficult questions or the individual who ultimately declined because they understood that participating was just not the right choice at that moment. Those conversations are simply not captured in a flow diagram or manuscript, yet are undoubtedly an essential part of human research.
Perhaps this is the hidden side of recruitment: standing at the intersection of scientific rigour and compassionate care. While we are entrusted with advancing research, we are equally entrusted with protecting patient autonomy and confronting difficult conversations with empathy. Those responsibilities are not in conflict - they depend on one another. In fact, science is at its strongest when participation is informed, voluntary, and built on trust.
So, my final takeaway is that sometimes success is a participant who asks thoughtful questions. Sometimes, success is helping someone feel heard during one of the most difficult chapters of their life. And sometimes, success is a well-informed “no”.
