ArticleJournal of evaluation in clinical practice2025
Lengthy Shifts and Decision Fatigue in Out-of-Hours Primary Care: A Qualitative Study.
Article in Journal of evaluation in clinical practice, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.
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Who cites it
5 citing papers in PubMed, 1 synthesis or guideline pooled it.
- An integrative review on unveiling the causes and effects of decision fatigue to develop a multi-domain conceptual framework.Frontiers in cognition · 2025Pooled it
- Organisational Problems, Role Stress, and Job Satisfaction Among Emergency Department Workers: A Multicenter Mixed-Effects Study.Journal of evaluation in clinical practice · 2026Article
- Clinical decision-making competencies and work readiness in senior nursing students: a path analysis study.BMC medical education · 2026Article
- Decision fatigue of surrogate decision-makers: a scoping review.BMC medical informatics and decision making · 2025Article
- Using EEG to Assess Cognitive Fatigue in Real Time: A Medical Simulation Study.Medical science educator · 2025Article
Corrections and comments
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Authors and funding
5 authors.
Funding
Abstract
rationaleDemands on healthcare workers are high: services are stretched, shifts are long and healthcare professionals (HCPs) regularly work lengthy periods without a break. Spending time continuously 'on task' changes decision-making in predictable ways, as described by the 'decision fatigue' phenomenon where decision-makers progressively shift towards making less cognitively effortful decisions as the time worked without a break increases. This phenomenon has been observed repeatedly in large quantitative observational studies, however, individual healthcare workers' experiences have not been explored.
aimsThis qualitative study aimed to explore general practitioners' (GPs) and advanced nurse practitioners' (ANPs) experiences of working for lengthy periods in an out-of-hours primary care service in the UK. This included exploration of self-perceived changes in decision-making throughout a work shift, and mitigating strategies used to avoid changes in decision-making over time.
designSemi-structured interviews were conducted online. An inductive thematic analysis was carried out to identify salient issues articulated by participants. SETTING AND
participantsThe interview sample (n = 10) comprised ANPs (n = 5) and GPs (n = 5) who regularly worked within the out-of-hours primary care service across a regional National Health Service (NHS) health board.
resultsHCPs (GPs and ANPs) provided insights into their experiences during lengthy shifts and the impact of prolonged periods of work on clinical decision-making. Four main themes were identified and developed: (1) HCPs are aware of decision fatigue effects over the course of a shift; (2) Multiple factors help and hinder stable decision-making quality; (3) HCPs deliberately use strategies to help keep the quality of their decision-making stable; and (4) HCPs are aware of contextual changes, likely related to the decision fatigue phenomenon.
conclusionsThe findings of this study underscore the intricate interplay of personal, social and systemic factors in decision-making quality and highlight HCPs' deliberate efforts to mitigate decision fatigue's effects in practice.
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