Patients who see their doctors in the morning are more likely to be referred for screenings for breast and colon cancer than patients with end-of-the-day appointments, a new study suggests.
Researchers poring over records of more than 50,000 patients who were eligible for breast or colon cancer screening saw a big drop in referrals as the day progressed. Patients were also less likely to actually get screened, once they had a referral, if they saw their doctors later in the day.
There are several possible explanations, said study co-author Dr. Mitesh Patel, an assistant professor the University of Pennsylvania’s Perelman School of Medicine and director of the Penn Medicine Nudge Unit.
First, Patel said: “As we go through our day we get tired of making decisions, so we’re less likely to do it later in the day. And then, as we go through our day, we tend to run behind schedule so at the end of the day we have less time.”
But there’s also a possible patient factor, Patel said, adding, “Patients at the end of the day may have less time because they’re in a rush to get home.”
As reported in JAMA Network Open, Patel and his colleagues analyzed electronic health records compiled between 2014 and 2016 by 33 primary care practices in Pennsylvania and New Jersey. They found 19,254 patients eligible for breast cancer screening and 33,468 eligible for colon cancer screening.
When examining those patients’ records, the researchers found that order rates for breast cancer screenings were at their highest at 8 a.m., at 63.7 percent, and dropped to 47.8 percent at 4 p.m. and 5 p.m. Similarly, order rates for colon cancer screenings at 8 a.m. were highest, at 36.5 percent, and dropped to 23.4 percent by 5 p.m.
That doesn’t mean patients should try to get appointments early in the day, Patel said. But it does suggest that doctors might want to look at ways to automate certain aspects of care. For example, Patel said, a recent study found that more patients were screened for colon cancer when stool test kits were automatically sent out.
The new study is “intriguing and a little provocative but I think we should be cautious before we start posing solutions,” said Dr. Albert Wu, an internist and professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health. “Correlation is not causality and we should always be cautious jumping to conclusions, particularly those that support a narrative we believe in.”
While the researchers have found an association between time of day and rate of cancer screenings, it doesn’t prove that the rate of screening depends on the time of day. Time of day might simply be a marker for some other factor, Wu said.
Wu pointed to a study of judges that similarly correlated time of day with the likelihood of a judge approving parole. In that case it turned out that prisoners who came before a judge later in the day tended to be the ones who didn’t have a lawyer to represent them, Wu said.
