Systematic review of the effects of decision fatigue in healthcare professionals on medical decision-making

Abstract

Decision fatigue is the tendency to make less effortful decisions as the cumulative mental burden of a lengthy period of decision-making increases. Health professionals working long shifts may be particularly vulnerable to decision fatigue, with implications for healthcare quality and efficiency. This preregistered systematic review (Prospero ID=CRD42021260081, no external funding) aims to synthesise the empirical evidence on decision fatigue in the healthcare context. A systematic search across eight databases identified 14,740 records. N=82 studies (72 quantitative, 1 qualitative, 1 review, 8 expert discussions) met the inclusion criteria (health professionals/trainees; medical decisions over time; healthcare context; any design). Study quality was assessed with the Mixed Methods Appraisal Tool or relevant JBI checklist. Narrative synthesis revealed that 45% of cases that quantitatively assessed the decision fatigue hypothesis provided clear evidence of significant decision fatigue effects across diagnostic, test ordering, prescribing, and therapeutic decisions. Expert discussions confirmed healthcare professionals' recognition of decision fatigue as an important and impactful phenomenon. However, decision fatigue as a psychological state was inconsistently defined and inadequately operationalised, reflecting limitations in current theoretical understanding of the effect. To address this gap, we propose defining decision fatigue as ‘a tendency towards making less effortful decisions as the cumulative burden of effortful decision-making increases.’ Future studies should prioritise the development and testing of different theoretical explanations for decision fatigue to improve understanding and facilitate the selection and testing of appropriate interventions.