Decision Fatigue in Health and Healthcare

In order to make decisions, people must take in and weigh up relevant information and make choices about the most appropriate course of action to take. While it is tempting to believe that within high stakes contexts such as healthcare, decisions will be based solely on logic and a balanced weighing of the information, human decision-making is susceptible to several measurable biases. One such bias is ‘decision fatigue’: a state occurring when mental resources become depleted and/or motivation to exert mental effort declines over time causing decision makers to progressively shift towards easier, safer, or more gratifying decisions (Pignatiello, Martin & Hickman, 2018).

Decision fatigue has been observed in multiple contexts. For example, in a highly-cited study of judicial decisions, Danziger, Levav and Avnaim-Pesso (2011) noted that the probability of a judge deciding to release a prisoner on parole at the beginning of the day was ~65%, but that this fell steadily to nearly 0% as time since the start of the court session wore on, returning to ~65% after a food/rest break and again falling steadily to 0% towards the end of the day. In this example, the ‘safest’ and therefore mentally easiest option was to maintain the status quo (denying parole) and the more depleted judges became, the more likely they were to select this conservative option until an opportunity arose (in the form of a break) to rest and replenish their resources.

Within the healthcare context, multiple studies have observed a predictable shift in decision making and effortful behaviours over time. For example, healthcare professionals’ compliance with hand hygiene protocols declines predictably from the start to the end of shifts (Dai, Milkman, Hofmann & Staats, 2015; Chudleigh, Fletcher & Gould, 2005), gastorenterologists are less likely to detect visible polyps during afternoon than morning colonoscopies (Chan, Cohen, & Spiegel, 2009), doctors prescribe more unnecessary antibiotics towards the end than the start of clinic sessions (Linder, Doctor, Friedberg, Reyes Nieva, Birks, Meeker & Fox, 2014) and nurses become increasingly likely, as time since their last break increases, to refer patients on to other health professionals for further assessment (Allan, Johnston, Powell, Farquharson, Jones, Leckie & Johnston, in press).

Such systematic changes in health-related decision processes over time have clear implications for service delivery and patient care. Consequently, the present PhD will focus on identifying possible determinants of decision fatigue and methods of counteracting them.

Specifically, the present PhD will aim to;

(a) Review the existing literature on decision fatigue

(b) Design and implement a series of experiments to identify the determinants of decision fatigue effects in different healthcare contexts (e.g. reading scans, triaging patients, making referrals etc.)

(c) Develop and pilot test interventions based on the results of (a) and (b) which can minimize decision fatigue effects by modifying identified determinants.

The successful candidate will have a background in psychology or a closely aligned behavioural science and have knowledge and/or experience of experimental design.

APPLICATION PROCEDURE:
This project is advertised in relation to the research areas of APPLIED HEALTH SCIENCE. Formal applications can be completed online: https://www.abdn.ac.uk/pgap/login.php. You should apply for Degree of Doctor of Philosophy in Applied Health Science, to ensure that your application is passed to the correct person for processing.

NOTE CLEARLY THE NAME OF THE SUPERVISOR AND EXACT PROJECT TITLE ON THE APPLICATION FORM.

Candidates should contact the lead supervisor to discuss the project in advance of submitting an application, as supervisors will be expected to provide a letter of support for suitable applicants. Candidates will be informed after the application deadline if they have been shortlisted for interview.