Association of Primary Care Clinic Appointment Time With Clinician Ordering and Patient Completion of Breast and Colorectal Cancer Screening

Abstract

Key Points Question Are breast and colorectal cancer screening rates associated with the time of day a patient visits the primary care clinician? Findings In this quality improvement study analysis of 33 primary care practices including 19 254 patients eligible for breast cancer screening and 33 468 patients eligible for colorectal cancer screening, both clinician ordering and patient completion of cancer screening tests decreased as the time of day progressed. Meaning Patients with primary care clinic appointment times later in the day were less likely to be ordered for and receive guideline recommended cancer screening.

Decision Fatigue, Running Late, and Population Health Management—Screening Out of Time

“…Another, simpler explanation for the association described by Hsiang In demonstrating decreasing screening rates over the day, Hsiang and colleagues 5…”

“…Two possible explanations for the results found by Hsiang and colleagues5 are decision fatigue and running late. Decision fatigue is a progressive erosion of ability, self-control, or willpower that occurs as people make choices.…”

“…and colleagues5 could be that clinicians have a tendency to get further behind as shifts go on. In becoming further behind and perhaps trying to catch up, clinicians may naturally omit certain aspects of care that are not immediately urgent, like ordering cancer screening.…”

Tolerance of Uncertainty and the Practice of Emergency Medicine

“…The literature on decision fatigue indicates that when fatigue sets in, people tend to resort to more conservative behaviors. Although the most widely publicized study of decision fatigue described the decline in parole offers for inmates during the course of the day, 40 this phenomenon has also been described for antibiotic prescribing (more during the course of a day), 41 influenza vaccinations and cancer screening orders (fewer), 42,43 hand hygiene compliance (less), 44 and adenoma detection during colonoscopies (less). 45 In emergency medicine, decision fatigue may manifest itself as lower thresholds for diagnostic testing and admission.…”

Clinician reminders increase cancer screening orders, but patients need prompts as well

“…A Penn Medicine study published in JAMA Network Open suggests that although flagging the electronic health records (EHRs) of patients who need cancer screenings is helpful, patients also need specific reminders to follow through 1 …”