PRE-CONFERENCE WORKSHOP III: SMART: EXPERIMENTAL DESIGN METHODS FOR DEVELOPING ADAPTIVE INTERVENTIONS

The prevention and management of many health disorders often entails a sequential, individualized approach whereby intervention is adapted and re-adapted over time in response to the specific needs and evolving status of the individual. Adaptive interventions provide one way to operationalize the strategies (e.g., continue, augment, switch, step-down) leading to individualized sequences of treatment.  An adaptive intervention is a sequence of decision rules that specify whether, how or when (timing), and based on which measures, to alter the dosage (duration, frequency or amount), type, or delivery of treatments in the course of an individual or patient’s care. Often, a wide variety of critical questions must be answered when developing a high-quality adaptive intervention.  Yet, there is often insufficient empirical evidence or theoretical basis to address these questions.  The Sequential Multiple Assignment Randomized Trial (SMART)—a type of experimental design—was developed explicitly for the purpose of building efficacious adaptive interventions. SMARTs represent an attractive alternative to the standard randomized clinical trial when the overarching aim is to construct (as opposed to evaluate) a high-quality adaptive intervention.