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The effect of choice bracketing — the consideration of repeated decisions as a set versus in isolation — has important implications for products that are inherently time-sensitive and entail varying levels of risk, including retirement accounts, insurance purchases, and lottery preferences. We show that broader choice brackets lead to more optimal risk preferences across all risk types, including negative expected value and pure-loss gambles, suggesting that broad decision framing can help individuals make better choices over risks more generally. We also examine the mechanism behind these bracketing effects. We find that bracketing effects work by attenuating (magnifying) the weight placed on potential losses for positive EV (non-positive EV) gambles and by providing aggregated outcomes that might not otherwise be calculated. Thus, decision frames that provide probability distributions or aggregated outcomes can help individuals maximize expected value across different types of risky prospects. % removed part about "largely unexplored" - I'm sure someone will % object to that.

The effect of choice bracketing — the consideration of repeated decisions as a set versus in isolation — has important implications for products that are inherently time-sensitive and entail varying levels of risk, including retirement accounts, insurance purchases, and lottery preferences. We show that broader choice brackets lead to more optimal risk preferences across all risk types, including negative expected value and pure-loss gambles, suggesting that broad decision framing can help individuals make better choices over risks more generally. We also examine the mechanism behind these bracketing effects. We find that bracketing effects work by attenuating (magnifying) the weight placed on potential losses for positive EV (non-positive EV) gambles and by providing aggregated outcomes that might not otherwise be calculated. Thus, decision frames that provide probability distributions or aggregated outcomes can help individuals maximize expected value across different types of risky prospects.

Introduction Robust randomised trial data have shown that routine preoperative (pre-op) testing for cataract surgery patients is inappropriate. While guidelines have discouraged testing since 2002, cataract pre-op testing rates have remained unchanged since the 1990s. Given the challenges of reducing low-value care despite strong consensus around the evidence, innovative approaches are needed to promote high-value care. This trial evaluates the impact of an interdisciplinary electronic health record (EHR) intervention that is informed by behavioural economic theory.Methods and analysis This pragmatic randomised trial is being conducted at UCLA Health between June 2021 and June 2022 with a 12-month follow-up period. We are randomising all UCLA Health physicians who perform pre-op visits during the study period to one of the three nudge arms or usual care. These three nudge alerts address (1) patient harm, (2) increased out-of-pocket costs for patients and (3) psychological harm to the patients related to pre-op testing. The nudges are triggered when a physician starts to order a pre-op test. We hypothesise that receipt of a nudge will be associated with reduced pre-op testing. The primary outcome will be the change in the percentage of patients undergoing pre-op testing at 12 months. Secondary outcomes will include the percentage of patients undergoing specific categories of pre-op tests (labs, EKGs, chest X-rays (CXRs)), the efficacy of each nudge, same-day surgery cancellations and cost savings.Ethics and dissemination The study protocol was approved by the institutional review board of the University of California, Los Angeles as well as a nominated Data Safety Monitoring Board. If successful, we will have created a tool that can be disseminated rapidly to EHR vendors across the nation to reduce inappropriate testing for the most common low-risk surgical procedures in the country.Trial registration number ClinicalTrials.gov identifier: NCT04104256.