By Joe Elia
Edited by Susan Sadoughi, MD, and André Sofair, MD, MPH
Physicians’ rates of ordering cancer screenings (and patients’ rates of completing them) fall dramatically as the day wears on, a JAMA Network Open study finds.
Researchers examined the scheduled times of over 50,000 primary-care visits by patients who were due for breast or colorectal screening. The study’s primary outcome was the percentage of resulting physician orders for the tests; the secondary outcome was the percentage of those tests completed by patients within a year.
Generally, 8 a.m. visits brought better physician ordering: 64% for breast screening, dropping to 48% for 5 p.m. visits. For colorectal screening the respective numbers were 37%, dropping to 23%. Patient completions followed a similar arc: 33% breast screening completion for early visits, 18% for late ones.
Editorialists ascribe the trend to, variously, decision fatigue or just falling farther behind and needing to “rush about like latter-day White Rabbits,” à la Lewis Carroll. The authors speculate that clinicians might have more time to explain the importance of screening earlier in the day.