When and How Assessment Matters: An Update on the Treatment Utility of Clinical Assessment (TUCA)
When and How Assessment Matters: An Update on the Treatment Utility of Clinical Assessment (TUCA)
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DOI：
10.1037/pas0000966
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发表时间：
2021-02-01
影响因子：
3.6
通讯作者：
Hopwood, Christopher J.
中科院分区：
文献类型：
--
作者：
Kamphuis, Jan H.;Noordhof, Arjen;Hopwood, Christopher J.
临床评估的治疗效用(TUCA)长期以来一直是一个有争议的话题，可以说有更多(强烈的)观点，而不是相关的、设计良好的实证研究。我们认为，这个问题的处理范围太广了，更有背景的方法可能会提供更多的信息。与其问“评估的治疗效用是什么”，我们建议更详细地说明和检查评估可以或不能促进治疗过程并最终使患者受益的条件。为此，我们提出了一个启发式模型，用于概念化临床评估可能具有治疗效用的条件，并通过区分四类特定的评估驱动干预来说明其用途。我们区分了直接收益和评估以及间接TUCA作为两条主要途径，强调了关于工作机制的一些先验理论的重要性，并强调了确保假定的中介变量有足够的可变性的要求。这些考虑反过来又主张对相关的结果测量有更广泛的看法，在TUCA研究中使用更强大的设计，并在临床实践中实施某种形式的阶段性评估。
The Treatment Utility of Clinical Assessment (TUCA) has long been a controversial topic, with arguably more (strong) opinions than relevant, well-designed empirical research. We argue that this question has been tackled too broadly and that a more contextualized approach would likely be more informative. Instead of asking "what is the treatment utility of assessment," we suggest specifying and examining more closely the conditions by which assessment can-or cannot- contribute to treatment process and ultimately patient benefit. To this end, we present a heuristic model for conceptualizing the conditions under which clinical assessment may have treatment utility and illustrate its use by distinguishing four specific classes of assessment-driven interventions. We distinguish direct benefits from assessment from indirect TUCA as two principal pathways, emphasize the importance of having some a priori theory regarding working mechanisms, and stress the requirements of ensuring adequate variability of the presumed mediating variables. These considerations in turn argue for a broader view of pertinent outcome measures, the use of more powerful designs in TUCA research, and the implementation of some form of stepped assessment in clinical practice.