Researchers Identify the Optimal Number of Treatment Options That Help Doctors Make Better Decisions
A new study from Northwestern University and the University of Sydney is shedding light on a surprisingly important question in everyday medical practice: How many treatment choices should doctors see when they’re making decisions for patients? It turns out that having more options helps—but only up to a point. And the researchers may have pinpointed the sweet spot.
This finding matters because doctors work under intense time pressure, often navigating busy clinic schedules, electronic health record (EHR) alerts, and complicated patient situations. While it may seem intuitive that offering more choices always improves care, real-world decision-making doesn’t work that way. Too few choices can restrict a doctor’s ability to deliver the best treatment, while too many can create decision fatigue. This study directly explored where the balance lies.
A Detailed Look at the Study Design
The study, published in JAMA Network Open, involved 402 primary care physicians across the United States. These doctors were presented with two common clinical scenarios through an EHR-style interface:
- Whether to refer a patient with hip osteoarthritis for surgery.
- Whether to prescribe opioids for a patient with back pain.
Each scenario included a default option—a “current management plan”—and then a list of appropriate alternatives. These alternatives were carefully selected so that every option shown to the physicians was considered reasonable and evidence-based.
The experiment split physicians into several groups:
- A control group that saw one appropriate alternative.
- Intervention groups that saw two, three, or four alternatives.
The key question was simple: Would doctors stick with the default plan or choose one of the alternatives?
What the Researchers Discovered
The results showed a clear pattern:
- Physicians given two or more alternatives chose an alternative about 62% of the time.
- Those given only one alternative chose it about 44% of the time.
That’s a significant jump—nearly a 20-percentage-point increase in choosing a non-default option when more alternatives were offered.
But here’s the twist:
Offering more than two alternatives didn’t improve decision-making any further.
Whether doctors saw two, three, or four alternatives, the rate stayed nearly the same.
The study also found no evidence of status-quo bias. Earlier research from 1995 suggested that too many choices might overwhelm doctors and push them to stick with the default. But this new trial didn’t support that theory. Instead, it found that providing multiple appropriate options actually encouraged physicians to move away from the default choice and select something more in line with recommended care.
Why This Matters for Everyday Medical Practice
Doctors are human. They experience cognitive overload, time constraints, and alert fatigue. EHR systems constantly push reminders, warnings, and prompts—some helpful, some outdated. When a decision-support tool interrupts a busy workflow, the design of that prompt can make a huge difference.
This study shows that:
- One alternative isn’t enough to nudge meaningful change.
- Two alternatives are optimal for improving decision quality.
- More than two adds no extra benefit and may crowd the screen unnecessarily.
In practical terms, a well-designed EHR could present two high-quality, evidence-based alternatives in a clear and concise way. This helps guide physicians toward better choices without overwhelming them.
The study’s authors emphasize that this isn’t about forcing doctors into specific actions. It’s about making it easier to do the right thing, especially in cases where the default choice isn’t the most effective or safest option.
The Specific Scenarios Used in the Study
To keep the experiment grounded in real issues, the researchers used two common primary-care dilemmas:
1. Hip Osteoarthritis and Surgery Referrals
Hip osteoarthritis is widespread, especially among older adults. Not every patient needs surgery immediately. Many appropriate alternatives exist, including:
- Physical therapy
- Anti-inflammatory medications
- Weight management
- Assistive devices
Presenting multiple valid options allows doctors to see a broader picture of patient care instead of jumping straight to a high-cost, invasive intervention.
2. Opioid Prescribing for Back Pain
This scenario is especially relevant given ongoing concerns about opioid overuse. Physicians face pressure to address patient pain while avoiding unnecessary opioid exposure. Alternatives may include:
- Non-opioid medications
- Physical therapy
- Activity modification
- Heat therapy
- Referral to pain specialists
By seeing several reasonable alternatives instead of a single one, physicians may be more inclined to avoid default opioid prescribing when safer options exist.
The Bigger Picture: Choice Architecture in Medicine
This research sits within the broader concept of choice architecture—the idea that the way options are presented influences decisions. It’s widely used in behavioral economics, public policy, and customer-facing technologies. In healthcare, choice architecture can shape clinical decisions subtly but powerfully.
A key takeaway from this study is that more information isn’t always better; the right amount of information is better.
Designing EHR interfaces around this principle could:
- Improve care quality
- Reduce overuse of low-value treatments
- Reduce underuse of safer or more effective alternatives
- Decrease unwarranted variation in care
- Support consistency across different clinical settings
These are all major priorities for health systems worldwide.
Additional Context: Why Doctors Experience Decision Fatigue
Doctors often make dozens or even hundreds of decisions per day. Factors contributing to decision fatigue include:
- Long clinical hours
- High patient volumes
- Repetitive administrative tasks
- Managing chronic diseases
- Interpreting EHR alerts
- Weighing medication risks and benefits
- Fielding urgent questions
- Coordinating follow-up care
What’s more, EHR systems often bombard clinicians with excessive alerts, many of which are irrelevant or outdated. When every alert demands attention, even important warnings can lose impact.
This is why well-designed EHR prompts are so valuable. They can relieve mental strain, streamline care, and reduce errors—if they’re built thoughtfully.
Limitations of the Study
Although informative, the study has several limitations worth noting:
- The scenarios were hypothetical, not real patient encounters.
- Physicians made choices in a survey environment, not during a packed clinic day.
- Only two clinical cases were used, limiting generalizability.
- Real-world patient preferences—an essential element of care—weren’t part of the study.
Still, the randomized design offers strong evidence, and the insights are highly relevant to how EHRs can be improved.
Why This Study Could Influence Future EHR Design
Health systems may use these findings to redesign decision-support tools. Instead of long lists of possible actions, systems could present two strong alternatives for common scenarios. This provides:
- Helpful nudges
- Reduced clutter
- Increased attention
- Better alignment with evidence-based care
If widely adopted, these kinds of changes could support quality improvement on a national scale.
