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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Veröffentlicht in:	Annual review of clinical psychology Jg. 8; S. 21
Hauptverfasser:	Lei, H, Nahum-Shani, I, Lynch, K, Oslin, D, Murphy, S A
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	United States 27.04.2012
Schlagworte:	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
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Beschreibung
Zusammenfassung:	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.
Bibliographie:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 ObjectType-Review-3 content type line 23
ISSN:	1548-5951 1548-5951
DOI:	10.1146/annurev-clinpsy-032511-143152