Framing effects in choices between multioutcome life-expectancy lotteries

Aim. To explore framing or editing effects and a method to debias framing i n a clinical context. Method. Clinical scenarios using multioutcome life-ex pectancy lotteries of equal value required choice's between two supplementa ry drugs that either prolonged or shortened life from the 20-year beneficia l effect of a baseline drug. The effects of these supplementary drugs were presented in two conditions, using a between-subjects design. In segregated editing (n = 116) the effects were presented separately from the effects o f the baseline drug. In integrated editing (n = 100), effects of supplement ary and baseline drugs were combined in the lottery presentation. Each subj ect responded to 30 problems. To explore one method of debiasing, another 1 00 subjects made choices after viewing both segregated and integrated editi ngs of 20 problems. (dual framing). Results. Statistically significant pref erence reversals between segregated and integrated editing of pure lotterie s occurred only when one framing placed outcomes in the gain domain, and th e other framing placed them in the loss domain. When both editings resulted in gain-domain outcomes only, there was no framing effect. There was a rel ated relationship of framing-effect shifts from losses to gains in. mixed-l ottery-choice problems. Responses to the dual framing condition did not con sistently coincide with responses to either single framing. In some situati ons, dual framing eliminated or lessened framing effects. Conclusion. The r esults support two components of prospect theory, coding outcomes as gains or losses from a reference point, and an s-shaped utility function (concave in gain, convex in loss domains). Presenting both alternative editings of a complex situation prior to choice mote fully informs the decision maker a nd may help to reduce framing effects. Given the extent to which preference s shift in response to alternative presentations, it is unclear which choic e represents the subject's "true preferences."