Identifying the Causes and Effects of Decision Fatigue through a Systematic Review (Extended Abstract)

Organizational decision-making can be natural and subconscious at times, but it often involves conscious planning and cognitive effort due to the varying degrees of complexity. Past studies revealed that decision-making in high-risk domains like healthcare, fire control, law enforcement, and rescue operations is challenging due to the significant impact of the decision-maker’s choices on outcomes (Penney et al., 2022). These intricacies give rise to the phenomenon called decision fatigue, which refers to the deteriorating quality of decisions an individual makes after a prolonged decision-making period (Pignatiello et al., 2020). Decision fatigue reduces workplace performance and leads individuals to make less optimal choices under fatigued conditions (Linder et al., 2014). Hence, exploring the causes and effects of decision fatigue across different occupational domains is critical. The objective of this study is to investigate the causes and effects of decision fatigue from the existing literature in an effort to increase the accuracy and efficiency of organizational decision-making.

A systematic search of scientific databases across Scopus, APA PsycInfo, and Google Scholar identified 589 studies that directly or indirectly addressed decision fatigue and organizational decision-making. The search used the keywords “decision fatigue” and “decision-making,” MeSH terms related to decision fatigue such as “cognitive fatigue,” “compassion fatigue,” and “alert fatigue,” and Boolean operators. Only English-language journal articles published between 2000 and 2023 were considered. Articles were screened using the PRISMA method, and quality was critically assessed using the Joanna Briggs Institute (JBI) appraisal method. Literature reviews and conceptual analyses, along with articles irrelevant to the study scope or those scoring less than 7 out of 10 in the JBI appraisal, were excluded. From the initial 589 articles, 18 met all inclusion criteria and were analyzed using root cause analysis and thematic synthesis.

From the 18 included studies, eight causes of decision fatigue were identified: presence of alternative decisions, frequency of decision-making, order of decisions, duration of decisions (time of day), responsibilities involved with the decision, complexity of decision-making, availability of breaks, and uncertainty of decisions. These causes were broadly classified as individual, organizational, and environmental. Four primary effects of decision fatigue were found: ineffective decision-making, conservativeness in decision-making, erroneous decisions, and perceived complexity in decision-making. Seven secondary effects were identified: reduced efficiency in decision-making, choosing the easiest option, wrongful decisions, inconsistencies in decision-making, choosing the option perceived as the safest, increased cognitive effort during decision-making, and a lower rate of decisions. The review synthesized cross-domain evidence and narrowed the initial pool of 589 studies to 18 high-quality, relevant articles.

The literature has only sparsely examined decision fatigue, despite evidence that improper decision-making can lead to catastrophic outcomes. In healthcare, for instance, over 98,000 deaths in the U.S. have been attributed to errors and biases associated with diagnostic decision-making (Kohn et al., 2000), with fatigue recognized as a leading contributor. Unlike prior studies focused on single professions, this review takes a broader cross-domain perspective on the causes and effects of decision fatigue. Empirical examples include reduced likelihood of scheduling surgeries as surgical shifts progress (Persson et al., 2019) and declines in antibiotic prescriptions toward the end of physician shifts (Trinh et al., 2021). Understanding the full set of causes can inform process improvements that make decision-making more robust, while knowledge of effects can guide the design of interventions to prevent or mitigate decision fatigue. Future research should objectively measure decision fatigue and quantify relationships between specific causes and the degree of fatigue.

This systematic review consolidates cross-domain evidence on decision fatigue, identifying eight causes categorized as individual, organizational, and environmental, and documenting four primary and seven secondary effects that degrade decision performance. By synthesizing findings from 18 high-quality studies, the work provides a foundation for designing interventions and process changes to improve decision-making accuracy and efficiency in organizational settings. Future research directions include developing objective measures of decision fatigue and quantitatively modeling how particular causes contribute to fatigue severity and downstream decision outcomes.