Can the time of day patients see their doctor impact their cancer care?

Can the time of day a patient sees a doctor reduce the chances the patient will get recommended for cancer screening—and if the patient does, whether they actually go through with the screening?

A new study published in the Journal of the American Medical Association suggests it can.

Led by University of Pennsylvania researcher Mitesh Patel, M.D., researchers looked at 33 physician practices that are part of the University of Pennsylvania Health System in either Pennsylvania or New Jersey with patients who were eligible for either breast or colorectal cancer screening.

They found the chances doctors would recommend screening were highest at 8 a.m. and lowest at 5 p.m.  

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"As the overall clinic day progresses, clinicians may face decision fatigue, defined as the depletion of self-control and active initiative that results from the cumulative burden of decision making," researchers wrote in the study. "In other words, as the day goes on, clinicians may be less likely to discuss cancer screening with patients simply because they have already done this (and made other decisions) a number of times."

Further, patients who were recommended cancer screening later in the day were less likely to actually get the screening within one year of the office visit.

"This indicates that decisions made during a single PCP visit may have a lasting effect on patient behavior," the authors wrote. "Clinicians may decide to defer discussion of cancer screening or other guideline-recommended care to future visits, and these findings indicate that this could potentially result in suboptimal care."

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The authors acknowledged observational study couldn't explain the reason for the drops, but suggested the decrease in completions might be tied to shorter patient visits as physicians fall behind, leading to the screening test discussion getting skipped.

The authors also recognized the limitations of the study being generalized to the greater healthcare system, because the research was conducted on practices that are part of a single health system.

But, they said, it is valuable for considering how the timing of physician visits might influence both physician and patient behavior when it comes to cancer screening.