As the Cookie Crumbles: Preparing for Patient Recruitment without Third-Party Cookies

  Martin Lawlor
Senior Executive, Corporate Services

Organizations conducting clinical trials have long relied upon the data gathered by third-party cookies to identify potential subjects during patient recruitment. As people have grown increasingly wary about sharing personal data online, particularly health-related information, companies that once allowed third-party cookies to harvest data have begun to eliminate them in the interest of user privacy.

Apple eliminated third-party cookies from its Safari browser in 2017, and Mozilla stopped collecting cookies in its Firefox browser in 2019. Meanwhile, Google announced similar plans in 2020 to phase out third-party cookies in Chrome, the most used web browser in the world. Although Google already allows users to opt out of third-party cookies on websites, the full elimination of third-party cookies has been delayed multiple times and may again be delayed.

If You Give a Website a Cookie

What exactly are you replacing, though?

There are two main types of cookies:

• First-party cookies are placed on users’ devices by the websites they visit and cannot be accessed by another web browser. Each website has the ability to specify what data it intends to capture with first-party cookies, but generally these cookies collect basic analytical data, remember preferred settings and keep track of website interactions and activities.

• Third-party cookies are placed on users’ devices by websites other than the ones they visit — usually by advertisers or other outside entities — and they track user behavior across any website where a third-party server places ads or tracking pixels.

You will still be able to utilize data collected through first-party cookies, which will continue to provide basic information about users and their website preferences. Third-party cookies, though, which collect expanded user data — data that has been instrumental in honing the patient recruitment process for clinical trials — are what Apple and Mozilla have already eliminated and what Google is preparing to abolish.

Change Your Recipe Now!

Even though Google’s current plan does not proactively block third-party cookies until 2024, now is the time to begin adapting your strategies for identifying potential clinical trials participants. Here are some existing alternate approaches you can consider as you begin updating your strategies:

1.     First-Party Cookies

First-party cookies collect data from the precise websites visited by users, and can be tailored to collect the data you want to collect. 

• Pros: Purchasing or collecting first-party cookies will likely become the new starting point for patient recruitment, and by using this information organizations will still be able to define and identify potential participants.

• Cons: Collecting data using first-party cookies relies on having an active website with heavy traffic. Websites for clinical trials and recruiters typically do not draw heavy traffic organically, which makes first-party cookies significantly less effective for data collection and audience targeting.

• Moving Forward: First-party cookies may also be targeted for elimination by Google’s Privacy Sandbox over privacy concerns, or their ability to collect data may be reduced. Apple has already taken these actions through its Intelligent Tracking Prevention (ITP) for its Safari web browser.

 
2.     Google Privacy Sandbox

Recognizing the chasm that will be created by the elimination of third-party cookies, and driven by an interest in providing its advertisers with detailed user information, Google has already begun to seek alternatives. Since 2019 it has been developing a set of APIs it collectively calls its Privacy Sandbox. 

• Pros: The purpose behind the Privacy Sandbox is to restructure how user data is collected and to improve user privacy. The Privacy Sandbox is expected to rely heavily on cohort analysis, which evaluates a website’s group data rather than the data of individuals and then assesses collective behaviors rather than individual behaviors. By decentralizing and de-identifying the data being collected, cohorts allegedly ensure user privacy, which seems to be the way audience targeting is moving.

• Cons: Early reviews say the Privacy Sandbox may be too limited to be an adequate alternative to third-party cookies for clinical trial recruiting. These reviews note that it yields data that is too general and does not incorporate data from other browsers. Moreover, despite being intended to preserve confidentiality, the actual privacy of some of its components — such as the Federated Learning of Cohorts (FLoC), a type of web tracking that groups people into "cohorts" based on their browsing history — has been questioned. The testing of FLoC was even postponed in Europe over concerns that it violates the European Union’s General Data Protection Regulation (GDPR).

• Moving Forward: Though still in testing phases, Google claims its Privacy Sandbox will not only better protect privacy, but also help content remain freely available without relying upon third-party cookies. Provided the privacy concerns surrounding cohort analysis are addressed, choice, transparency and control for users — including the ability to opt in or out of Privacy Sandbox — are also expected to improve as its components are worked out.

3.     Contextual Targeting

Contextual targeting utilizes keywords and search engine marketing (SEM) to target websites that are relevant to your service or campaign for ad placement. While it does not capture personal data, that information — such as IP addresses and access time — could be obtained through the website host. 

• Pros: Contextual targeting works best when the website being visited has specifically themed content and therefore attracts visitors with specific interests.

• Cons: Again, there are limitations to contextual targeting, the primary one being it does not identify specific users or their demographics. Target keywords must also be precisely chosen to ensure the desired information is gathered.

• Moving Forward: Once thought to be all but obsolete because of third-party cookies, contextual targeting now appears to be primed to step in as their replacement. Because it does not rely upon personal data, contextual targeting carries no regulatory burdens regarding user privacy provided only information about the website and specific page (e.g., content, keywords, URL) is collected. In addition, increased integration with deep learning should improve keyword understanding in context and eliminate the hyper-specificity of keywords.

4.     Data Tracking Platforms & Data Mining

Data tracking platforms collect, refine, build and distribute data about target audiences across various online platforms. Similarly, data mining companies collect data, find patterns and create databases based upon the patterns the data yields. Both tools rely upon first-party data that is licensed and shared between entities to provide the relevant data that may be used to identify potential clinical trial participants.

• Pros: One advantage of using data from tracking platforms and mining companies is they understand the behaviors and preferences of web users and your target audience. They also provide data analytics that further refine their offerings. Data tracking platforms and data mining companies therefore have the ability to provide you with better resources, which you can use to hone your target audience.

• Cons: Some of these types of organizations have come under fire, and even faced lawsuits, for the way they gather and disseminate their data. Therefore, the potential ethical and regulatory issues posed by their processes must be considered before engaging a partner in this area. These sources can also be cost prohibitive with some carrying price tags in excess of $200,000.

• Moving Forward: There are many data tracking and data mining vendors out there, and each of them measures, stores and reports on digital data, which they then sell to organizations looking to hone their target audiences. These data collectors may be the next best way, in the absence of third-party cookies, to identify and qualify clinical trial participants. 

BBK's Approach

Display Ads

In the past, BBK has used Facebook display ads to target users through a combination of demographic data points (e.g., age, gender and location) and health-related interests (although the latter is no longer an option). An additional prospecting tactic has been implemented, called "lookalike targeting," which uses pixel data to find people who have similar demographics and online habits as those who successfully completed the online prescreening.

By contrast, Google performs no targeting in search ads other than keywords and location; however, similar to Facebook, once someone clicks on a search ad, we can retarget them with Google Display Ads. Display ads can also be used in broad search based on information people have shared voluntarily with Google.

What We're Cooking Up

For the last few months, BBK has been working toward integrating population profile data to shape our strategies and improve recruitment outcomes. Through this data, we hope to be able to identify which site locations have a large enough number of patients to help focus recruitment, to advise sponsors regarding which sites they should activate, to learn more about a patient's treatment journeys, and to determine which criteria may make or break recruitment efforts. 

Between now and 2024, Google or other organizations looking to fill the gap left by the elimination of third-party cookies likely will develop additional means of gathering data. Until then, clinical trials should begin basing their strategies for participant recruitment around what is available. Currently, it appears that data from first-party cookies and contextual targeting will be the starting points for establishing target audiences for patient recruitment, but the most effective strategy will combine tried-and-true approaches with emerging solutions.

BBK Worldwide will continue to monitor the industry to keep you abreast of emerging solutions and to continue to optimize our offerings.