Decision Fatigue in the ICU: Physician’s Perspectives and a Typology of Fatigue-Prone Decisions – A Qualitative Interview Study

Background: The concept of Decision fatigue (DF) originates from research in social psychology and refers to a state of cognitive and self-regulatory exhaustion consequential to repeated decision making. It is assumed that making decisions consumes a limited resource of mental energy which can impair the quality of subsequent decisions. As this resource is depleted, the ability to exercise self-control declines, which can lead to less considered, more impulsive decisions or even no decision at all. Although the concept of DF has been acknowledged over many areas, previous studies in the medical context have shown inconclusive results. This study explored intensive care physicians’ views and experiences on DF and its potential impact on medical decision making in the intensive care unit (ICU). Methods: 19 semi-structured interviews were conducted in person with ICU physicians from October 2024 to March 2025. All interviews were audio-recorded, transcribed verbatim, and analysed using the framework method until data saturation was achieved. Results: 19 physicians from three different ICUs participated, including 13 residents and board-certified specialists in executing roles and 6 consultants with supervisory and treatment-planning responsibilities. Three major themes were identified and developed: (1) DF and mental exhaustion occur in the ICU; (2) DF influences both the decision-making process and the outcome of decisions; and (3) physicians indicate various characteristics of decisions in which the effects of DF are more likely to occur. Conclusions: This study provides new insights into ICU physicians’ experiences of DF. Understanding which decisions are most vulnerable to DF may help guide future research and interventions to support clinical decision-making.