Decision fatigue of surrogate decision-makers: a scoping review

Abstract Background Surrogate decision-makers are prone to decision fatigue when faced with medical decisions, which might compromise decision quality. Objective Conducting a scoping review of studies related to decision fatigue in surrogate decision-makers, this work synthesizes the current state of decision fatigue, its influencing factors, assessment tools, and coping strategies, providing a reference for the implementation of decision support. Methods Guided by scoping review methodology, we systematically searched databases including the Cochrane Library, PubMed, Embase, Web of Science, CINAHL, CNKI, COVIP, and Wanfang databases as well as pertinent grey literature was carried out. Two researchers were responsible for the selection, extraction, and analysis of the literature, and Cohen’s kappa was calculated to determine interrater reliability. Results The initial search retrieved 2048 documents, from which 25 articles were ultimately selected for inclusion. Among the included articles, 15 (60%) were cross-sectional studies, 1 (4%) was a longitudinal study, 6 (24%) were qualitative research, 1 (4%) was a randomized controlled trial, and 2 (8%) were quasi-experimental studies. The decision fatigue scores of surrogate decision makers in critically ill patients varied from 5.2 to 14.18, whereas those in non-critically sick patients ranged from 10.53 to 23.97. The primary evaluation tools were the Decision Fatigue Scale, which included versions DFS-7, DFS-9, and DFS-10. In surrogate decision-making, decision fatigue is influenced by decision behaviour factors, self-regulation factors, and situational factors, suggesting the multidimensional character of decision fatigue. The coping strategies included health education and intrinsic motivation interventions. Conclusions Although decision fatigue is common among surrogate decision makers, there are variations in study scores that require further investigation to confirm. Assessment tools lack diversity and are inconsistent. Decision fatigue is influenced by multiple factors. In the future, new assessment tools should be introduced and developed with the goal of quickly identifying and thoroughly assessing the causes and mechanisms of decision-making fatigue among surrogate decision makers. The intervention outcomes lacked generalizability. Future research should focus on developing targeted, multi-centre interventions with large sample sizes to reduce decision fatigue, improve decision quality, and promote a healthcare decision-making system.