Physicians order fewer cancer screenings later in day, study finds

Physicians are less likely to write orders for cancer screening tests later in the day, which could create gaps in preventive care for patients, according to a study published in JAMA Network Open.

For the study, researchers analyzed data on adult patients eligible for breast or colorectal cancer screenings at 33 primary care clinics in Pennsylvania and New Jersey. They tracked the patients from Sept. 1, 2014, to Aug. 31, 2016.

Researchers found screening test order rates for breast cancer were highest at 8 a.m. (63.7 percent) and fell to 47.8 percent at 5 p.m. For colon cancer screenings, order rates were 36.5 percent at 8 a.m. and dropped to 23.4 percent at 5 p.m. Patients who saw their physicians later in the day were also less likely to have completed their screening tests a year later.

Decision fatigue and rushed primary care visits in the afternoons are two factors that could be responsible for this trend, study author Mitesh Patel, MD, director of the Penn Medicine Nudge Unit in Philadelphia, wrote in an op-ed for STAT.

"The take-home lesson from this work is that medical decisions made later in the day may not be as good as those made earlier, but that subtle changes to electronic health records and taking new approaches to delivering care can make time irrelevant," he concluded.

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