DCTs are progressing from disillusionment to enlightenment, with key areas for improvement including data integration, patient diversity, regulatory harmonization, and long-term engagement. Oncology trials benefit from DCTs, reducing patient burden and enhancing accessibility. Site-level acceptance of DCT elements requires fair compensation, efficient training, and user-friendly interfaces. Collaboration, technology support, and proper resourcing are essential for DCT success. The future of DCTs lies in seamless integration with healthcare systems and optimizing patient experiences.