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Cancer Screening Rates Linked to Time of Medical Appointment

woman stands in kitchen with son and looks at her calendar to make appointment

It can be tricky to fit medical appointments into a busy schedule of work, school, and other activities. Now a study suggests patients may want to take something else into consideration when deciding what time of day to visit their primary care doctor. Researchers from the University of Pennsylvania say when patients see their doctor may affect whether they are told to get screened for cancer, and the likelihood of patients to have them done. The study was published May 20, 2019 in JAMA Network Open.

Researchers looked at data of more than 50,000 adults eligible for breast cancer screening or colorectal cancer screening who visited 33 primary care clinics in Pennsylvania and New Jersey from 2014 through 2016. The study found doctors ordered cancer screenings more often for patients with appointment times earlier in the day than later in the day.  For example, they ordered breast cancer screening for eligible patients with an 8am appointment 64% of the time compared with 48% for patients with a 5pm appointment. They ordered colorectal cancer screening for eligible patients with an 8am appointment time 37% of the time compared with 23% for patients with a 5pm appointment.

The researchers also tracked whether the patients had completed screening within a year of their appointment. Not surprisingly, as the number of cancer screening referrals declined with appointment later in the day, so did the number of people actually going to get screened. Completion of breast cancer screening among the patients who’d had an 8am doctor appointment stood at 33% compared with 18% for those who’d had a 5pm or later appointment. Completion of colorectal cancer screening among the patients who’d had an 8am appointment stood at 28% compared with 18% for those who’d had a 5pm or later appointment. This indicates that decisions made during a single primary care visit may have a long-lasting effect.

The researchers did note that even though orders for cancer screenings fell throughout the day, there was a brief spike around noon before they began falling again. The same trend was reflected in screening completion rates. The researchers speculate lunch breaks may give doctors an opportunity to catch up and start fresh.

Decision fatigue and running late

The researchers came up with 2 possible reasons for their study results: decision fatigue and running late. Decision fatigue refers to the way people tend to get tired or worn down over the course of their day, and sometimes make decisions that require less energy. In addition, doctors tend to get further behind schedule as their shift goes on and may have shorter and more rushed meetings with patients at the end of the morning and afternoon shifts. They may put off aspects of care that are not urgent, including cancer screening orders. The doctor may also be less likely to discuss cancer screening simply because they have discussed it so many times already that day with other patients.

The study authors say there is an opportunity to improve screening rates by taking appointment time into consideration. For example, a prompt in the electronic health record could remind the doctor to order screening no matter the time of day. In the meantime, patients with late appointment times may want to ask their doctor questions about cancer screening.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Association of Primary Care Clinic Appointment Time With Clinician Ordering and Patient Completion of Breast and Colorectal Cancer Screening. Published May 20, 2019 in JAMA Network Open. First author Esther Y. Hsiang, BA, University of Pennsylvania, Philadelphia.