MEDICAL DECISION-MAKING IN SITUATIONS THAT OFFER MULTIPLE ALTERNATIVES

Objective.-To determine whether situations involving multiple options can paradoxically influence people to choose an option that would have been declined if fewer options were available. Design.-Mailed survey containing medical scenarios formulated in one of two versions. Partic ipants.-Two groups of physicians: members of the Ontario College of Fa mily Physicians (response rate=77%; n=287) and neurologists and neuros urgeons affiliated with the North American Symptomatic Carotid Endarte rectomy Trial (response rate=84%; n=352). One group of legislators bel onging to the Ontario Provincial Parliament (response rate=32%; n=41). Intervention.-The basic version of each scenario presented a choice b etween two options. The expanded version presented three options: the original two plus a third. The two versions otherwise contained identi cal information and were randomly assigned. Outcome Measures.-Particip ants' treatment recommendations. Results.-ln one scenario involving a patient with osteoarthritis, family physicians were less likely to pre scribe a medication when deciding between two medications than when de ciding about only one medication (53% vs 72%; P<.005). Apparently, the difficulty in deciding between the two medications led some physician s to recommend not starting either. Similar discrepancies were found i n decisions made by neurologists and neurosurgeons concerning carotid artery surgery and by legislators concerning hospital closures. Conclu sions.-The introduction of additional options can increase decision di fficulty and, hence, the tendency to choose a distinctive option or ma intain the status quo. Awareness of this cognitive bias may lead to im proved decision making in complex medical situations.