The behavioral dynamics of clinical trials.
Two ways of approaching the design of long-term clinical trials are presented and contrasted. The first, termed the "static" view, emphasizes close adherence to formal rules of study design. The second, termed the "dynamic" view, emphasizes the behavioral aspects of patient participation in trials of long duration. The dynamic view is discussed in detail, with discussion of how recruitment of participants, random assignment to conditions, compliance with protocol, and measurement of outcomes are affected by behavioral dynamics. Data from a recently completed tamoxifen toxicity trial are used to illustrate the points and to focus the discussion of behavioral dynamics on the design of a chemoprevention trial for breast cancer using tamoxifen.
Leventhal
H
H
Institute for Health, Health Care Policy, and Aging Research, Division on Health, Rutgers University, New Brunswick, New Jersey 08903.
Nerenz
D R
DR
Leventhal
E A
EA
Love
R R
RR
Bendena
L M
LM
D001294:Attitude to Health; D001943:Breast Neoplasms / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology*; D002985:Clinical Protocols / Q000592:standards; D002986:Clinical Trials as Topic / Q000592:standards*; D003659:Decision Making, Organizational; D005260:Female; D006801:Humans; D009937:Organizational Objectives; D010349:Patient Compliance / Q000523:psychology; D010358:Patient Participation; D012106:Research / Q000458:organization & administration*; D012107:Research Design / Q000592:standards*; D012307:Risk Factors; D015983:Selection Bias; D013629:Tamoxifen / Q000009:adverse effects / Q000627:therapeutic use*
D013629:Tamoxifen