A "SMART" Design for Building Individualized Treatment Sequences
A "SMART" Design for Building Individualized Treatment Sequences
复制标题
DOI：
10.1146/annurev-clinpsy-032511-143152
复制
发表时间：
2012-01-01
期刊：
影响因子：
--
通讯作者：
Murphy, S. A.
中科院分区：
文献类型：
--
作者：
Lei, H.;Nahum-Shani, I.;Murphy, S. A.
干预往往涉及一系列决定。例如，临床医生经常根据个人的结果调整干预措施。随着时间的推移改变干预的强度和类型是至关重要的，原因有很多，例如，如果个人没有反应，则可以获得改善，或者在不再需要强化治疗时减少成本和负担。适应性干预利用个体变量（严重程度，偏好）来调整干预，然后动态地利用个体结果（对治疗的反应，坚持）来重新调整干预。序贯多重分配随机试验（SMART）提供了可用于构建适应性干预措施的高质量数据。我们回顾SMART，并强调其优势，在构建和修改适应性干预相比，替代实验设计。SMART研究的选择的例子进行了描述和比较。提供了一种数据分析方法，并使用纳洛酮SMART研究的扩展治疗有效性数据进行说明。
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.