Framing effects in choices between multioutcome life-expectancy lotteries.
OBJECTIVE
To explore framing or editing effects and a method to debias framing in a clinical context.


METHODS
Clinical scenarios using multioutcome life-expectancy lotteries of equal value required choices between two supplementary drugs that either prolonged or shortened life from the 20-year beneficial 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 of the baseline drug. In integrated editing (n = 100), effects of supplementary and baseline drugs were combined in the lottery presentation. Each subject responded to 30 problems. To explore one method of debiasing, another 100 subjects made choices after viewing both segregated and integrated editings of 20 problems (dual framing).


RESULTS
Statistically significant preference reversals between segregated and integrated editing of pure lotteries occurred only when one framing placed outcomes in the gain domain, and the 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 related relationship of framing-effect shifts from losses to gains in mixed-lottery-choice problems. Responses to the dual framing condition did not consistently coincide with responses to either single framing. In some situations, dual framing eliminated or lessened framing effects.


CONCLUSIONS
The results 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 more fully informs the decision maker and may help to reduce framing effects. Given the extent to which preferences shift in response to alternative presentations, it is unclear which choice represents the subject's "true preferences."
Bernstein
L M
LM
Department of Medical Education, University of Illinois College of Medicine, University of Illinois at Chicago, USA.
Chapman
G B
GB
Elstein
A S
AS
D000293:Adolescent; D000328:Adult; D002755:Choice Behavior; D003661:Decision Support Techniques; D004358:Drug Therapy / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008017:Life Expectancy; D008297:Male; D015233:Models, Statistical; D009042:Motivation; D011336:Probability; D018570:Risk Assessment