Fighting decision fatigue

Stewart, Adam F.; Ferriero, Donna M.; Josephson, S. Andrew; Lowenstein, Daniel H.; Messing, Robert O.; Oksenberg, Jorge R.

doi:10.1002/ana.23531

Cited by 20 publications

(18 citation statements)

References 3 publications

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“…Efficacy of the educational intervention, a secondary outcome measure, was defined as a reduction in TI based on each individual response. We also evaluated secondary outcome the capability of the intervention to protect against decision fatigue decision fatigue [defined as the difference in TI within groups before (Block 1) and after the intervention (Block 2)] ( 36 , 37 ). A significantly higher prevalence of TI in the 10 case-scenarios post-intervention (Block 2) would be indicative of decision fatigue.…”

Section: Methodsmentioning

confidence: 99%

Overcoming Therapeutic Inertia in Multiple Sclerosis Care: A Pilot Randomized Trial Applying the Traffic Light System in Medical Education

et al. 2017

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BackgroundPhysicians often do not initiate or intensify treatments when clearly warranted, a phenomenon known as therapeutic inertia (TI). Limited information is available on educational interventions to ameliorate knowledge-to-action gaps in TI.ObjectivesTo evaluate the feasibility and efficacy of an educational intervention compared to usual care among practicing neurologists caring for patients with multiple sclerosis (MS).MethodsWe conducted a pilot double-blind, parallel-group, randomized clinical trial. Inclusion criteria included neurologists who are actively involved in managing MS patients. Participants were exposed to 20 simulated case-scenarios (10 cases at baseline, and 10 cases post-randomization to usual care vs. educational intervention) of relapsing–remitting MS with moderate or high risk of disease progression. The educational intervention employed a traffic light system (TLS) to facilitate decisions, allowing participants to easily recognize high-risk scenarios requiring treatment escalation. We also measured differences between blocks to invoke decision fatigue. The control group responded as they would do in their usual clinical practice not exposed to the educational intervention. The primary feasibility outcome was the proportion of participants who completed the study and the proportion of participants who correctly identified a high-risk case-scenario with the “red traffic light.” Secondary outcomes included decision fatigue (defined as an increment of TI in the second block of case-scenarios compared to the first block) and the efficacy of the educational intervention measured as a reduction in TI for MS treatment.ResultsOf 30 neurologists invited to be part of the study, the participation rate was 83.3% (n = 25). Of the 25 participants, 14 were randomly assigned to the control group and 11 to the intervention group. TI was present in 72.0% of participants in at least one case scenario. For the primary feasibility outcome, the completion rate of the study was 100% (25/25 participants). Overall, 77.4% of participants correctly identified the “red traffic light” for clinical-scenarios with high risk of disease progression. Similarly, 86.4% of participants correctly identified the “yellow traffic light” for cases that would require a reassessment within 6–12 months. For the secondary fatigue outcome, within-group analysis showed a significant increased prevalence of TI in the second block of case-scenarios (decision fatigue) among participants randomized to the control group (TI pre-intervention 57.1% vs. TI post-intervention 71.4%; p = 0.015), but not in the active group (TI pre-intervention 54.6% vs. TI post-intervention 63.6%; p = 0.14). For the efficacy outcome, we found a non-significant reduction in TI for the targeted intervention compared to controls (22.6 vs. 33.9% post-intervention; OR 0.57; 95% CI 0.26–1.22).ConclusionAn educational intervention applying the TLS is feasible and shows some promising results in the identification of high-risk scenarios to reduce decision fatigue and...

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Section: Methodsmentioning

confidence: 99%

Overcoming Therapeutic Inertia in Multiple Sclerosis Care: A Pilot Randomized Trial Applying the Traffic Light System in Medical Education

et al. 2017

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“…They report an increased desk rejection rate on days with large submission volume, specifically the desk rejection rate is 64% when the editor reviews 1 or 2 manuscripts a day, and it increases to 70% for 3+ reviewed manuscripts per day. Stewart et al (2012) provide other evidence consistent with decision fatigue of the editors, but stop short of a formal investigation of this hypothesis. In a relevant study, Johnston et al (2007) conducted a randomized trial to examine if desk rejection would significantly disadvantage the authors due to potential editorial bias.…”

Section: Related Literaturementioning

confidence: 94%

“…Improvement in the speed of first decision can make a journal more attractive to authors, with a resulting increase in the submission volume. Some editors wonder if the increased submissions to their journals are going to affect the quality or accuracy of editorial decisions (Stewart et al 2012). One of the questions asked by Stewart et al (2012) is whether the editor's decisions are influenced by the number of manuscripts submitted on the same day?…”

Section: Related Literaturementioning

confidence: 99%

“…Some editors wonder if the increased submissions to their journals are going to affect the quality or accuracy of editorial decisions (Stewart et al 2012). One of the questions asked by Stewart et al (2012) is whether the editor's decisions are influenced by the number of manuscripts submitted on the same day? They report an increased desk rejection rate on days with large submission volume, specifically the desk rejection rate is 64% when the editor reviews 1 or 2 manuscripts a day, and it increases to 70% for 3+ reviewed manuscripts per day.…”

Section: Related Literaturementioning

confidence: 99%

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Sequential order as an extraneous factor in editorial decision

Orazbayev

2017

Scientometrics

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Academic journal editors reject a significant portion of first submissions without sending them out for peer review. This decision, desk rejection, is made to reduce the workload on associate editors and referees, to give the submitting author a head start on revision or pursuit of an alternative venue, as well as to achieve quicker turnaround time for the journal. Desk rejection is a judgement based on the manuscript's perceived quality, impact and fit with the journal's scope. Could extraneous factors, which are unrelated to the content of a manuscript, affect the editorial decision? This paper examines whether the sequential order in which manuscripts are submitted to a large academic journal affects the editorial decision. Becoming the first submission on the editor's list of manuscripts to review increases the probability of a desk rejection by up to 7% without any effect on the likelihood of a rejection after peer review.

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“…Some disappointed authors have expressed the view that these requirements are onerous and that the Annals , as the official journal of the ANA, has an obligation to communicate a larger number of reasonable investigations from its members. We've considered these comments, and other feedback, in depth as part of an ongoing self‐evaluation of our performance as editors, and we are especially delighted that the new online journal Annals of Clinical and Translational Neurology will now be able to provide an additional home for our members' work.…”

mentioning

confidence: 99%