More options, more action: contradicting a classic finding
From Donald Redelmeier and Eldar Shafir’s (1995) classic paper in JAMA, the Journal of the American Medical Association:
Intervention: The basic version of each scenario presented a choice between two options. The expanded version presented three options: the original two plus a third. …
Results: In one scenario involving a patient with osteoarthritis, family physicians were less likely to prescribe a medication when deciding between two medications than when deciding about only one medication (53% vs 72%; P < .005). Apparently, the difficulty in deciding between the two medications led some physicians to recommend not starting either. Similar discrepancies were found in decisions made by neurologists and neurosurgeons concerning carotid artery surgery and by legislators concerning hospital closures.
Conclusions: The introduction of additional options can increase decision difficulty and, hence, the tendency to choose a distinctive option or maintain the status quo.
The paper has been cited 622 times as of today.
From a new paper by Gemma Altinger et al. (2025) in JAMA Network Open (I’m one of the et al.):
Question Does offering multiple appropriate treatment alternatives affect the odds of primary care physicians choosing an alternative over the current care plan?
Findings In this randomized clinical trial of 402 primary care physicians, offering 2 or more appropriate alternatives significantly increased the odds that physicians would choose an alternative (62%) compared with those offered only 1 alternative (44%).
Meaning Contrary to prior studies suggesting status-quo bias, in this trial, presenting multiple appropriate alternatives in decision support alerts increased the odds that physicians would choose an alternative; indicating that presenting multiple alternatives may improve clinical decision-making and reduce unwarranted variation in health care.
