When my vehicle sits for a long time it starts fine. After running around town with frequent start and stops, it starts very rough and sometimes it takes two or three times to turn it over.
I don't know if your truck uses this method but several vehicles I have owned would turn on the electric cooling fan to combat the natural temperature rise that occurs in the engine once the coolant is not circulating anymore.
This prevents hard starting in a hot engine and if the thermostatic switch fails that controls the fan, the cooling (and turn-on) doesn't happen.
This may be your problem.
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