Abstract
Rationale
Demands 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.
Aims
This 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.
Design
Semi-structured interviews were conducted online. An inductive thematic analysis was carried out to identify salient issues articulated by participants.
Setting and Participants
The 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.
Results
HCPs (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.
Conclusions
The 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.
Demands 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.
Aims
This 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.
Design
Semi-structured interviews were conducted online. An inductive thematic analysis was carried out to identify salient issues articulated by participants.
Setting and Participants
The 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.
Results
HCPs (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.
Conclusions
The 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.
| Original language | English |
|---|---|
| Article number | e70050 |
| Number of pages | 10 |
| Journal | Journal of Evaluation in Clinical Practice |
| Volume | 31 |
| Issue number | 2 |
| Early online date | 13 Mar 2025 |
| DOIs | |
| Publication status | Published - 13 Mar 2025 |
Bibliographical note
Open access via the Wiley agreementThis study was supported by the NHS Grampian Endowment Fund(Grant ID: 21/002) and by a University of Aberdeen Institute of Applied Health Sciences PhD Studentship awarded to M.M. The funders had no role in the study
Data Availability Statement
The dataset generated and analysed during the current study is confidential due to the lack of participant consent for sharing and the risk of identification. Therefore, the data cannot be made publicly available.Funding
NHS Grampian (GrantNumber(s): 21/002)
| Funders | Funder number |
|---|---|
| NHS Grampian | 21/002 |
Keywords
- clinical decision‐making
- decision fatigue
- general practitioners
- interview
- medical decision making
- nurses