Prevention trials: their place in how we understand the value of prevention strategies.
Several key factors bear on the interpretation of prevention trials and observational studies that inform prevention strategies. These factors include the underlying disease process and aspects of the intervention: sustainability of behavior change, the time course of the intervention within the disease process, dose and duration of exposure needed to effect risk reduction, durability of the impact of intervention, and methodological problems in implementing and interpreting randomized trials and observational studies to evaluate prevention strategies. The question asked through an intent-to-treat analysis of a randomized controlled trial (RCT) differs from that in the observational setting. Furthermore, the long duration necessary to conduct prevention trials and the resulting lack of adherence to therapy can bias results toward the null. A broader range of approaches to evaluate prevention interventions and programs with improved knowledge synthesis and translation to public health practice will speed our progress toward achieving public health and prevention of chronic diseases.
Colditz
Graham A
GA
Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri 63110, USA. colditzg@wustl.edu
Taylor
Philip R
PR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000008:administration & dosage; D015982:Bias; D002908:Chronic Disease; D055317:Evidence-Based Practice; D005260:Female; D006801:Humans; D008297:Male; D008327:Mammography; D008403:Mass Screening; D008875:Middle Aged; D010349:Patient Compliance; D004364:Pharmaceutical Preparations / Q000008:administration & dosage; D011322:Primary Prevention / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D040242:Risk Reduction Behavior; D014612:Vaccines / Q000008:administration & dosage
D000890:Anti-Infective Agents; D004364:Pharmaceutical Preparations; D014612:Vaccines