(a.k.a. “adaptive treatment strategy” or “dynamic treatment regime” or "treatment policy") A course of time-varying treatment designed to adapt to an individual’s changing life circumstances, response to treatment, or other designated indicator.
Some intervention programs can be divided into multiple stages, where at each stage a decision is made regarding treatment. Examples of decisions include how to deliver the treatment, the type of treatment, and whether to augment treatment. Each decision relies on current and past information on the individual. The goal of all stages is to achieve high quality outcomes.
Behavioral interventions for prevention and treatment are an important part of the fight against drug abuse and conditions such as HIV/AIDS and mental illness. Among the challenges faced by scientists is how and when to alter the course of treatment for participants in the intervention.
Adaptive interventions (also known as "adaptive treatment strategies" or “dynamic treatment regimens”) are individually tailored treatments. Formally, an adaptive intervention is a sequence of decision rules that specify how the intensity or type of treatment should change depending on the patient's needs. We are developing sequential, multiple assignment, randomized trials (SMART) to enable scientists to build adaptive interventions.
SMART Designs in the Field
Despite the fact that SMART is a recent innovation, many SMART designs have been funded and conducted. We have compiled a list of SMARTs addressing a broad range of health problems from substance use to depression.
Why Conduct a SMART to Build an Adaptive Intervention?
Interventions that adapt at the right times can improve participant outcomes (e.g., intensifying for people who do not respond to the initial treatment) while decreasing the cost and burden of the intervention (e.g., stepping down treatment for responsive participants). SMART designs provide the data needed to construct high-quality adaptive interventions.
Introductory Example: Using Medication to Prevent Alcoholism Relapse
SMART allows scientists to operationalize adaptive clinical decision making. In SMART interventions, scientists use data-based evidence to inform decision making about how and when to alter a patient's treatment.
In this example, researchers designed a trial to test how best to use the drug Naltrexone (NTX) in the treatment of alcoholism relapse. The trial tested how to classify relapse and what treatments best compliment NTX.