Imagine that you have just received a colon cancer diagnosis and need to choosebetween two different surgical treatments. One surgery, the "complicatedsurgery," has a lower mortality rate (16% vs. 20%) but compared to the othersurgery, the "uncomplicated surgery," also carries an additional 1% risk of eachof four serious complications: colostomy, chronic diarrhea, wound infection, oran intermittent bowel obstruction. The complicated surgery dominates theuncomplicated surgery as long as life with complications is preferred overdeath.
In our first survey, 51% of a sample (recruited from the cafeteria of auniversity medical center) selected the dominated alternative, the uncomplicatedsurgery, justifying this choice by saying that the death risks for the twosurgeries were essentially the same and that the uncomplicated surgery avoidedthe risk of complications. In follow-up surveys, preference for theuncomplicated surgery remained relatively consistent (39%-51%) despite (a)presenting the risks in frequencies rather than percents, (b) grouping the 4complications into a single category, or (c) giving the uncomplicated surgery asmall chance of complications as well. Even when a pre-decision "focusingexercise" required people to state directly their preferences between life witheach complication versus death, 49% still chose the uncomplicated surgery.
People’s fear of complications leads them to ignore important differencesbetween treatments. This tendency appears remarkably resistant to debiasingapproaches and likely leads patients to make healthcare decisions that areinconsistent with their own preferences.