People who see their doctors later in the day are less likely to get the cancer screenings for which they are eligible, according to new findings published in JAMA Network Open, reports Penn Medicine News.
Researchers at the University of Pennsylvania analyzed data from 2014 to 2016 across 33 primary care practices in Pennsylvania and New Jersey. Investigators identified whether patients who were eligible for screenings at these practices (about 19,000 for breast cancer and 33,000 for colorectal cancer) were given a screening recommendation and tracked how many of the patients actually completed screenings within a year of their appointment.
Doctors were more likely to order breast and colorectal cancer screenings for patients who saw them around 8 a.m. than those who had appointments at around 5 p.m. What’s more, the one-year completion rate for breast cancer screening was 33% for those who’d had appointments in the morning versus 18% for those who’d had appointments in the afternoon; for colon cancer, those rates were 28% versus 18%, respectively.
Study investigators noted that doctors may put off discussions about screenings for future appointments and assume that decisions regarding such screenings will be made next time. Furthermore, gaps in screening sometimes occur because certain screenings require coordination with other departments and an additional doctor visit.
There was one exception to the drop in order rates as the day progressed. Breast and colon cancer screening orders spiked when people met with their doctors around noon. This may be attributed to lunch breaks, which allow physicians time to get caught up on work and return refreshed.
“We believe that the downward trend of ordering may be the result of ‘decision fatigue,’ where people may be less inclined to consider a new decision after they’ve been making them all day,” said Esther Hsiang, MD, a Wharton School of Business student and a researcher with the Penn Medicine Nudge Unit who was the lead study author. “It may also stem from overloaded clinicians getting behind as the day progresses.”
How time of day influences behaviors should be factored in when developing future interventions that hope to improve cancer screening, concludes Hsiang. Scientists may also start looking at how computerized nudges, which can remind doctors about screenings during patient visits, could also be beneficial.
For more on cancer screenings, click here.