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Of these, twelve were interviewed in\u2010depth about fatigue and eleven about cognitive impairment. Interviews were conducted virtually, audio\u2010recorded, transcribed and analysed. The Theory of Unpleasant Symptoms guided the development of a PSC symptom conceptual framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Participants were on average 42\u2009years old, 57% male, 71% White and 57% had inflammatory bowel disease. Half experienced fatigue and cognitive impairment daily, while others described varying frequencies of these symptoms. Most participants described fatigue getting progressively worse throughout the day, often requiring naps. Fatigue interfered with domestic duties, job responsibilities and family\/social activities. Fatigue impacted mental health with frustration, sadness and guilt. Participants with cognitive impairment reported it ranged from mild to severe, with some unable to live independently or maintain employment. Working memory, verbal fluency, attention and processing speed were impacted. Fatigue and cognitive impairment frequently co\u2010occurred but could occur separately.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>PSC\u2010related fatigue and cognitive impairment impact daily, work\u2010related, emotional and social functioning in symptomatic adults. These qualitative findings inform the customization of PSC\u2010specific fatigue and cognitive function measures with strong content validity that is necessary for use in PSC research and clinical trials.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/liv.70814","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T04:37:23Z","timestamp":1785818243000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Fatigue and Cognitive Impairment in Adults With Primary Sclerosing Cholangitis: Results From Concept Elicitation Interviews"],"prefix":"10.1111","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1414-1846","authenticated-orcid":false,"given":"Donna M.","family":"Evon","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology University of North Carolina  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaya","family":"Merkler","sequence":"additional","affiliation":[{"name":"Center for Gastrointestinal Biology and Disease University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Mkumba","sequence":"additional","affiliation":[{"name":"Department of Population Sciences Duke University School of Medicine Durham  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6326-4922","authenticated-orcid":false,"given":"Nicole","family":"Lucas","sequence":"additional","affiliation":[{"name":"Department of Population Sciences Duke University School of Medicine Durham  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Wright","sequence":"additional","affiliation":[{"name":"Department of Population Sciences Duke University School of Medicine Durham  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4326-8720","authenticated-orcid":false,"given":"Joanne","family":"Hatchett","sequence":"additional","affiliation":[{"name":"PSC Partners Seeking a Cure  Greenwood Village Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5111-4568","authenticated-orcid":false,"given":"Rachel","family":"Gomel","sequence":"additional","affiliation":[{"name":"PSC Partners Seeking a Cure  Greenwood Village Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick J.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Psychiatry University of North Carolina  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0923-4300","authenticated-orcid":false,"given":"Sasha","family":"Deutsch\u2010Link","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology University of North Carolina  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3906-6811","authenticated-orcid":false,"given":"Christopher L.","family":"Bowlus","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology University of California Davis School of Medicine  Sacramento California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0919-4468","authenticated-orcid":false,"given":"Mark G.","family":"Swain","sequence":"additional","affiliation":[{"name":"Department of Medicine Liver Unit, University of Calgary  Calgary Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6709-8714","authenticated-orcid":false,"given":"Bryce B.","family":"Reeve","sequence":"additional","affiliation":[{"name":"Department of Population Sciences Duke University School of Medicine Durham  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.32771"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.15271"},{"key":"e_1_2_12_4_1","article-title":"Symptom Burden Is Associated With Health\u2010Related Quality of Life Insymptomatic Adults With Primary Sclerosing Cholangitis","author":"Evon D. 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