Using SMART design to improve symptom management among cancer patients: A study protocol
The burden of symptoms resulting from cancer and its treatment contribute to diminished health related quality of life (HRQOL), as has been well‐documented (Badger, Segrin, & Meek, 2011; Brant, 2016; Cleeland et al., 2013). Existing static symptom management interventions deliver a predetermined dose at specific intervals and are tested against controls in standard randomized controlled trials (RCTs). Although overall efficacy of an intervention may be established, heterogeneity may still exist in patient responses, and moderators of treatment outcomes may be identified that define groups of patients who benefit from interventions differentially (Kraemer, Wilson, Fairburn, & Agras, 2002; Sikorskii et al., 2015). While the identification of moderators is one step toward accounting for heterogeneity, the next step of intervention sequencing and tailoring is needed to advance intervention science (Knobf et al., 2015) and the science of cancer symptom management in particular. In this SMART design approach, we rigorously test the adjustment of intervention type and/or duration through sequencing that is based on patient response.