In a new episode of the Rethinking Clinical Trials Podcast, Christine Goertz and Steven George of Duke University discussed slow recruitment mitigation strategies, one of the small group discussion topics at the NIH Pragmatic Trial Collaboratory’s 2026 Annual Steering Committee Meeting.

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Goertz and George expanded on some of the common themes and lessons learned from the group discussion in April.

“The problem with recruitment is always the same… You’re not getting enough people to enroll in your study. But the reasons are always different,” said Goertz.

The best way for pragmatic trialists to get ahead of recruitment challenges, both investigators noted, is to set up the infrastructure to catch them early.

“ What it comes down to is having a consistent way to monitor so you know when you’re starting to fall off,” said George.

It can also put the research team in a good position to take corrective action, he noted: “ The benefit of monitoring is, in some ways, it just gives everyone a scoreboard to work towards. I find it depersonalizes things. You’re not blaming one person or one part of the study team.”

The discussion also covered strategies for locating weak spots in the protocol; engaging communities and study partners; and identifying creative solutions.

Goertz is a professor in musculoskeletal research at Duke University and a co–principal investigator for IMPACt-LBP, an NIH Collaboratory Trial. George is the Laszlo Ormandy Distinguished Professor of Orthopaedic Surgery at Duke University and a co–principal investigator of the AIM-Back trial.