|Title||Getting SMART about developing individualized sequences of health interventions|
|Year of Publication||2012|
|Authors||Almirall, D, and Susan A. Murphy|
The effective management of a wide variety of chronic health disorders often requires individualized, sequential decision making, whereby treatment is dynamically adapted over time based on a patient's changing course. Adaptive health interventions operationalize individualized, sequential, decision making via a sequence of decision rules that specify whether, how, for whom, and when to alter the intensity, type, or delivery of psychosocial, behavioral, and/or pharmacological treatments at critical decision points in the management of chronic disorders. In this talk, we present a novel, experimental design--sequential multiple assignment randomized trials, or SMART--intended specifically for the purpose of developing and optimizing adaptive health interventions. We will discuss why adaptive health interventions are important; introduce SMART designs; discuss SMART design principles, including common choices for primary and secondary aims; and discuss sample size considerations in the design of SMART. If time permits, we will discuss the conduct of SMART pilot studies for addressing feasibility and acceptability issues prior to conducting a full-scale SMART study.