Building games into multicenter clinical trial systems to boost trial engagement - PubMed (original) (raw)

Building games into multicenter clinical trial systems to boost trial engagement

Ryan Majkowski et al. Trials. 2026.

Abstract

Background: Workplace gamification refers to the translation of ordinary work tasks into a fun thematic framework-using game design elements such as points, competition, and recognition-to enhance engagement and motivation. Clinical trials are lengthy and operationally demanding, leading to low enthusiasm and disengagement. As a trial coordinating center, we successfully put gamification to work as an engagement tool in a series of multicenter clinical trials.

Methods: We combined trial metadata with gamification and concepts around motivation to enhance how we engaged site teams responsible for trial activation, patient recruitment and retention, protocol compliance, and data quality. Using metrics routinely captured within trial data platforms, performance indicators were extracted and converted into point-based scoring systems. Gamified strategies were integrated into start-up and enrollment phases of each clinical trial, as both phases had measurable tasks with defined timelines.

Results: We successfully gamified the start-up tasks of seven trials and enrollment tasks of nine trials. As start-up tasks were similar, one game fits multiple trials. Gamification was customized, however, for enrollment processes and further adapted to address protocol-specific challenges and periods of suboptimal performance. Drawing from these experiences, we present a set of guidelines that outline key principles and gamification mechanics, serving as instructions for game development in this context.

Conclusion: Gamification guidelines afford a novel approach to align intrinsic motivators for achievement with existing trial infrastructure and performance metrics to enhance trial team engagement across diverse trial settings.

Keywords: Clinical trial performance; Multicenter clinical trials; Site start-up; Trial Innovation Network; Workplace gamification.

© 2026. The Author(s).

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests.

Figures

Fig. 1

Fig. 1

An attractive and easy to follow electronic data capture (EDC) scoreboard example for a trial using the Tour de France game. The scoreboard shows the relevant metrics and scores. In this trial, scoring was based on numbers screened, data quality, and webinar attendance

Fig. 2

Fig. 2

An example of transforming a start-up metric into a game and reward system is to use the “Mount Everest Climb,” an approach designed to (1) recognize and reward site adherence to a timed start-up plan and (2) assist sponsors and coordinating center managers and monitors track the start-up process in a fun and competitive way. “The Summit” (activation) is reached after the team makes it through an exhilarating climb past the “Valley of Silence” (IRB & contracts), scaling the icy Lhotse Wall (regulatory [essential] documents), the final Lhotse Wall (training), and finally the “Death Zone” (investigator meeting or site visit). At the end of the climb, an award ceremony can be held at an investigator meeting, site initiation, or through a remote broadcast, to recognize the site teams that first completed required site-activation tasks and otherwise have successful accomplishments to share. Recognition goes a long way

Fig. 3

Fig. 3

The Tour de France style game is a point-based design for gaming during the trial enrollment cycle and can be easily programmed reports from trial electronic data capture (EDC) systems. Episodic subgames can be programmed for any given metric for monthly bonuses that can allow trailing teams to catch the leading teams

Fig. 4

Fig. 4

The Superhero game is a threshold-based design and is useful when automation within an electronic data capture (EDC) is not feasible or there is not a central platform to display results. Scores can be extracted from data coordinating center reports and displayed monthly through website postings, monthly webinars, or individual communications with site teams, affirming that gamification can occur manually with minimal technical needs

References

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