Understanding patient decision making with respect to clinical trial participation has the potential to improve both the efficiency of recruitment for clinical trials and their management. In this mini-review we consider 3 key factors influencing clinical trial recruitment outcomes that include; 1) patient personal characteristics, 2) enabling factors that involve patient centered attitudes or circumstances, and 3) aversion. These factors are explored across both Australian rural and urban settings and contrasted to reported outcomes from research across other countries. Australia has the lowest number of publications on rural clinical trial participation when compared to rural research in America and Canada. Across Australian urban areas where all 3 factors have been studied, trends are similar to those reported in other developed countries. In conclusion we suggest that trial participation could be improved if participants are better informed about a trial as this is a valuable factor to enable recruitment.