A "SMART" design for building individualized treatment sequences

Interventions often involve a sequence of decisions. For example, clinicians frequently adapt the intervention to an individual's outcomes. Altering the intensity and type of intervention over time is crucial for many reasons, such as to obtain improvement if the individual is not responding or...

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Bibliographic Details
Published in:Annual review of clinical psychology Vol. 8; p. 21
Main Authors: Lei, H, Nahum-Shani, I, Lynch, K, Oslin, D, Murphy, S A
Format: Journal Article
Language:English
Published: United States 27.04.2012
Subjects:
Humans
Mental Disorders - therapy
Patient-Centered Care - methods
Program Development - methods
Program Evaluation - methods
Randomized Controlled Trials as Topic - methods
Research Design
United States
United States
ISSN:1548-5951, 1548-5951
Online Access:Get more information
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Summary:Interventions often involve a sequence of decisions. For example, clinicians frequently adapt the intervention to an individual's outcomes. Altering the intensity and type of intervention over time is crucial for many reasons, such as to obtain improvement if the individual is not responding or to reduce costs and burden when intensive treatment is no longer necessary. Adaptive interventions utilize individual variables (severity, preferences) to adapt the intervention and then dynamically utilize individual outcomes (response to treatment, adherence) to readapt the intervention. The Sequential Multiple Assignment Randomized Trial (SMART) provides high-quality data that can be used to construct adaptive interventions. We review the SMART and highlight its advantages in constructing and revising adaptive interventions as compared to alternative experimental designs. Selected examples of SMART studies are described and compared. A data analysis method is provided and illustrated using data from the Extending Treatment Effectiveness of Naltrexone SMART study.
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ISSN:1548-5951
1548-5951
DOI:10.1146/annurev-clinpsy-032511-143152