Nav: Home

Cancer screening rates decline when patients see doctors later in day

May 10, 2019

Compared to patients who see their primary care doctor earlier in the day, cancer screening rates decline significantly as the day goes on, according to a new study from researchers in the Perelman School of Medicine and the Wharton School both of the University of Pennsylvania. The researchers, whose findings were published today in JAMA Network Open, believe these rates of decline may be in part due to "decision fatigue" -- which results from the cumulative burden of screening discussions earlier in the day -- and doctors falling behind in their busy schedules.

"Our findings suggest that future interventions targeting improvements in cancer screening might focus on time of day as an important factor in influencing behaviors," said the study's lead author, Esther Hsiang, a Wharton Business School student and researcher with the Penn Medicine Nudge Unit. "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. It may also stem from overloaded clinicians getting behind as the day progresses."

The researchers found that, among eligible patients, primary care doctors ordered breast cancer screening more often for patients seen in the 8 a.m. hour (64 percent) as compared to those with appointments at 5 p.m. (48 percent). Similarly, for colon cancer screening, tests were also ordered more frequently for 8 a.m. patients (37 percent) compared to those coming in later in the day (23 percent).

Examining data from 2014 through 2016 across 33 Pennsylvania and New Jersey primary care practices, the researchers found that ordering rates had far-reaching effects. When looking at the entire population eligible for screenings at these practices (roughly 19,000 for breast cancer and 33,000 for colorectal cancer), the researchers tracked whether the patients completed a screening within a year of their appointment. The data showed that the downward trend associated with the timing of the appointments carried over.

Breast cancer screening--which included mammograms--stood at a 33 percent one-year completion rate for the entire eligible population who had their appointment in the 8 a.m. hour. But for those who had clinic visits at 5 p.m. or later, just 18 percent completed screenings. For colorectal cancer, screenings such as colonoscopies, sigmoidoscopies, and fecal occult blood tests were completed by 28 percent of the patients with appointments in the 8 a.m. hour. That number dropped to 18 percent for patients who saw the doctor at 5 p.m. or later.

The one-year completion results cast long shadows. While doctors may simply be deferring discussions about screening to future appointments, it assumes that the decision will be made the next time. Additionally, these types of cancer screenings also require coordination with a different department and another visit on the part of the patient, which provide several opportunities for further lapses in screening.

Researchers also observed that although order rates fell as the day progressed, there was a brief spike in screening orders for breast and colon cancers when patients saw their clinician around noon. For example, breast cancer screening orders dropped to 48.7 percent at 11 a.m. but increased to 56.2 percent around noon, before gradually falling off again. This trend held true for one-year completion rates, as well. The study team suggest that this may be due to lunch breaks that give clinicians and opportunity to catch up and start fresh.

A downward trend in outcomes by hour was noted in a study in 2018 examining the rates of flu vaccinations by the time of day when patients saw a clinician. In that study, a "nudge" was built into the system that prompted doctors to accept or decline an influenza vaccine order, which helped spur an increase of vaccinations by nearly 20 percent, as compared to patients with doctors who weren't nudged.

"Our new study adds to the growing evidence that time of day and decision fatigue impacts patient care," said Mitesh Patel, MD, MBA, director of the Penn Medicine Nudge Unit and an assistant professor of Medicine. "In past work, we've found that nudges in the electronic health record can be used to address these types of gaps in care, which we suspect will be the case here. Future research could evaluate how nudges may be implemented in order to improve cancer screening."
-end-
Other Penn authors on this study included Shivan Mehta, Dylan Small, Charles Rareshide, Christopher Snider and Susan Day.

University of Pennsylvania School of Medicine

Related Breast Cancer Articles:

Partial breast irradiation effective treatment option for low-risk breast cancer
Partial breast irradiation produces similar long-term survival rates and risk for recurrence compared with whole breast irradiation for many women with low-risk, early stage breast cancer, according to new clinical data from a national clinical trial involving researchers from The Ohio State University Comprehensive Cancer Center - Arthur G.
Breast screening linked to 60 per cent lower risk of breast cancer death in first 10 years
Women who take part in breast screening have a significantly greater benefit from treatments than those who are not screened, according to a study of more than 50,000 women.
More clues revealed in link between normal breast changes and invasive breast cancer
A research team, led by investigators from Georgetown Lombardi Comprehensive Cancer Center, details how a natural and dramatic process -- changes in mammary glands to accommodate breastfeeding -- uses a molecular process believed to contribute to survival of pre-malignant breast cells.
Breast tissue tumor suppressor PTEN: A potential Achilles heel for breast cancer cells
A highly collaborative team of researchers at the Medical University of South Carolina and Ohio State University report in Nature Communications that they have identified a novel pathway for connective tissue PTEN in breast cancer cell response to radiotherapy.
Computers equal radiologists in assessing breast density and associated breast cancer risk
Automated breast-density evaluation was just as accurate in predicting women's risk of breast cancer, found and not found by mammography, as subjective evaluation done by radiologists, in a study led by researchers at UC San Francisco and Mayo Clinic.
More Breast Cancer News and Breast Cancer Current Events

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Rethinking Anger
Anger is universal and complex: it can be quiet, festering, justified, vengeful, and destructive. This hour, TED speakers explore the many sides of anger, why we need it, and who's allowed to feel it. Guests include psychologists Ryan Martin and Russell Kolts, writer Soraya Chemaly, former talk radio host Lisa Fritsch, and business professor Dan Moshavi.
Now Playing: Science for the People

#537 Science Journalism, Hold the Hype
Everyone's seen a piece of science getting over-exaggerated in the media. Most people would be quick to blame journalists and big media for getting in wrong. In many cases, you'd be right. But there's other sources of hype in science journalism. and one of them can be found in the humble, and little-known press release. We're talking with Chris Chambers about doing science about science journalism, and where the hype creeps in. Related links: The association between exaggeration in health related science news and academic press releases: retrospective observational study Claims of causality in health news: a randomised trial This...