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. 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. Decision fatigue reduces workplace performance and leads individuals to make less optimal choices under fatigued conditions. 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.

The paper situates decision fatigue within prior research highlighting high-risk decision-making contexts (e.g., healthcare, emergency services) and its consequences. Prior studies have shown time-of-day effects and the impact of workload on clinical decisions, such as reduced likelihood of scheduling surgeries as shifts progress and changes in antibiotic prescribing toward the end of shifts. Foundational work has also noted that diagnostic errors and biases contribute to adverse outcomes, with fatigue being a leading contributor. These works underscore the need for a cross-domain synthesis of causes and effects of decision fatigue.

A systematic search was conducted across Scopus, APA PsycInfo, and Google Scholar for English-language journal articles published between 2000 and 2023 that directly or indirectly addressed decision fatigue and organizational decision-making. Search terms included “decision fatigue” and “decision-making,” along with MeSH-related terms such as “cognitive fatigue,” “compassion fatigue,” and “alert fatigue,” combined with Boolean operators. Screening followed PRISMA guidelines, and study quality was assessed using the Joanna Briggs Institute (JBI) appraisal method. Literature reviews, conceptual analyses, irrelevant articles, and those scoring below 7/10 on the JBI appraisal were excluded. Of 589 initial records, 18 studies met all inclusion criteria. The selected studies were synthesized using root cause analysis and thematic synthesis.

From 18 included studies, eight causes of decision fatigue were identified: (a) presence of alternative decisions, (b) frequency of decision-making, (c) order of decisions, (d) duration/time of day, (e) responsibilities involved with decisions, (f) complexity of decision-making, (g) availability of breaks, and (h) uncertainty of decisions. These were broadly classified by origin into individual, organizational, and environmental causes. Effects were categorized as primary and secondary: four primary effects included (a) ineffective decision-making, (b) conservativeness in decision-making, (c) erroneous decisions, and (d) perceived complexity in decision-making. Seven secondary effects included 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 emphasizes that while decision fatigue has been less extensively explored, improper decision-making can lead to catastrophic errors, such as those seen in diagnostic contexts where fatigue is a major contributor. Unlike studies focused on single professions, this synthesis spans multiple domains to identify shared causes and effects of decision fatigue. Empirical examples include reduced likelihood of scheduling surgeries as shifts progress and time-of-day related changes in physician prescribing. By clarifying causes and mapping primary-to-secondary effects, the findings can inform strategies to streamline decision processes and design interventions to mitigate decision fatigue. The authors note the importance of future work to objectively measure decision fatigue and quantify relationships between causes and the degree of fatigue.

This systematic review synthesizes cross-domain evidence to identify eight key causes and a structured set of primary and secondary effects of decision fatigue, offering a broader perspective beyond single-profession studies. The findings can guide the development of interventions to smooth and support decision processes in organizations. Future research should focus on objectively measuring decision fatigue and quantifying the links between specific causes and the magnitude of decision fatigue across contexts.

The study is limited to English-language journal articles published between 2000 and 2023 and ultimately includes 18 studies, which may constrain generalizability. As a synthesis of existing literature (extended abstract), it relies on secondary data and does not provide objective measurements of decision fatigue or quantified causal relationships, which the authors note as directions for future research.