Grignoli Nicola, Manoni Greta, Gianini Jvan, Schulz Peter, Gabutti Luca, Petrocchi Serena
Cantonal Sociopsychiatric Organisation, Public Health Division, Department of Health and Social Care, Repubblica e Cantone Ticino, Mendrisio, Switzerland
Institute of Family Medicine, Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Ticino, Switzerland.
Fam Med Community Health. 2025 Feb 8;13(1):e003033. doi: 10.1136/fmch-2024-003033.
Decision fatigue (DF) can lead to impaired judgement, decreased diagnostic accuracy and increased likelihood of medical errors. Research on DF is scarce, and little is known about its nature in the clinical context. The objective of the present review was to provide a comprehensive framework to understand how the construct of DF in medical settings has been defined and measured. This review aimed to understand DF determinants and consequences and capture motivational factors overlooked in the existing reviews.
Systematic and scoping review (ScR) with meta-synthesis.
Empirical and non-empirical papers on clinical DF or related constructs directly impacting clinical decision-making were considered, with doctors of all ages, sexes and nationalities as participants. The Preferred Reporting Item for Systematic Reviews and Meta-analyses scoping review checklist has been applied and checked.
Six databases were systematically searched by two independent researchers according to a predefined set of keywords.
43 papers were included, of which 25 were empirical. The quantitative studies outnumber the qualitative ones and primarily involved residents in Europe/UK and North America. Internal medicine and primary care were the most studied disciplines. Only one sequential cross-sectional study measured DF in the medical setting, and all other studies addressed the construct indirectly. A conceptual analysis of clinical DF, including narrative contributions, a thematic analysis of the data extracted and a meta-synthesis, is provided. Clinical DF was investigated mostly by individual risk factors analysed through multiple intertwined determinants involving cognitive, emotional, behavioural, social and ethical aspects. Relevant risks, protective factors and negative outcomes circularly increasing DF are outlined.
The review gives solid arguments for developing a clear and coherent definition of clinical DF that allows the implementation of preventive targeted intervention.
This systematic review was pre-registered in PROSPERO on 8 November 2023 (available online at: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023476190, registration number CRD4202347619).
决策疲劳（DF）可导致判断力受损、诊断准确性下降以及医疗差错发生的可能性增加。关于决策疲劳的研究较少，在临床背景下对其本质了解甚少。本综述的目的是提供一个全面的框架，以理解在医疗环境中决策疲劳这一概念是如何被定义和测量的。本综述旨在了解决策疲劳的决定因素和后果，并捕捉现有综述中被忽视的动机因素。
采用元综合的系统综述和范围综述（ScR）。
考虑了关于临床决策疲劳或直接影响临床决策的相关概念的实证和非实证论文，参与者为所有年龄、性别和国籍的医生。应用并检查了系统评价和元分析范围综述清单的首选报告项目。
两位独立研究人员根据一组预定义的关键词系统地搜索了六个数据库。
纳入43篇论文，其中25篇为实证研究。定量研究数量多于定性研究，主要涉及欧洲/英国和北美的住院医师。内科和初级保健是研究最多的学科。只有一项序贯横断面研究在医疗环境中测量了决策疲劳，所有其他研究都是间接涉及这一概念。提供了对临床决策疲劳的概念分析，包括叙述性贡献、对提取数据的主题分析和元综合。临床决策疲劳大多通过个体风险因素进行研究，这些因素通过涉及认知、情感、行为、社会和伦理方面的多个相互交织的决定因素进行分析。概述了循环增加决策疲劳的相关风险、保护因素和负面结果。
该综述为制定清晰连贯的临床决策疲劳定义提供了有力论据，以便能够实施预防性的针对性干预。
PROSPERO注册号：本系统综述于2023年11月8日在PROSPERO上进行了预注册（可在线获取：https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023476190，注册号CRD4202347619）
