Intended for healthcare professionals

Editorials Christmas 2021: Trading Places

Retaining trial participants takes more than a Christmas card

BMJ 2021; 375 doi: (Published 14 December 2021) Cite this as: BMJ 2021;375:n2870

Linked Research

Bah humbug! Association between sending Christmas cards to trial participants and trial retention

  1. Jeremy Taylor, director for public voice
  1. National Institute for Health Research, Twickenham, UK
  1. jeremy.taylor{at}

A serious strategic approach is needed, with participants as respected partners

“Bah humbug! Sending Christmas cards to trial participants does not increase retention.” So conclude Coleman and colleagues in their linked study of nearly 1500 participants in eight different trials (doi:10.1136/BMJ-2021-067742).1 Participants sent a Christmas card featuring a winter scene with the words “Seasons Greetings” on the front were no more likely to attend their next scheduled follow-up than were controls who did not receive a card.

As the UK Government says in a recent policy document, “Patients and participants are the foundation of clinical research. Without them research can’t happen and healthcare can’t improve.”2 Recruiting and retaining participants is a central preoccupation for clinical research. Would we expect Christmas cards to make a difference?

The Good Clinical Trials Collaborative, an international best practice collaboration, espouses the principle that good randomised clinical trials (RCTs) “respect the rights and well-being of participants.”3 The Collaborative notes the centrality of trust, which it says “is undermined when RCTs are not sufficiently relevant, fair, transparent, and respectful of the rights, interests, …

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