If you want proper cancer screening, book an early morning appointment, new research suggests.
Patients were as much as 37 percent more likely to be screened for cancer if they had an 8am appointment than if they had one at 5pm, according to a new University of Pennsylvania.
Fatigue, backlogs and running behind schedule amount to chronic problems of the healthcare industry.
The researchers think that doctors get tired, in particular, of making important decisions over and over throughout the day.
And the compounding effects could be putting patients’ lives at risk, if worn out doctors are running out of energy to check patients for cancer by the end of the day.
Doctors spend their entire days making choices that could have very real impacts on patients’ lives – and by the end of the day, they’re tired of it, which explain why they are less likely to order cancer screenings for 5pm patients than they are for 8am patients, a study found
Screening is the first line of defense against cancer.
We can do everything in our power to live healthy lifestyles to reduce our cancer risks, but at the end of the day, sometimes cells will simply go awry.
And not all cancer is obviously detectable to the untrained eye, so proper screening is the best shot we have to catch cancer early, when it is most isolated and treatable.
Whether or not a patient needs to be screened for colon or breast cancer – and most types – depends on their age, medical and family histories and risk factors (both genetic and lifestyle).
But doctors may have another consideration in mind.
University of Pennsylvania researchers analyzed data on about 52,000 patients who were eligible for cancer screening and had appointments with their primary care physicians between 2014 and 2016.
For women that were eligible for breast cancer screening, doctors ordered a screening for 64 percent of patients that had appointments at 8am, and about a third received a mammogram or other test for the disease within the year.
But by the time the 5pm appointments rolled around, only 48 percent of patients were deemed in need of a cancer screening, and just 18 percent actually got one within the year.
Screening referrals and completions declined at similar rate for colorectal screenings.
Doctors ordered colonoscopies for 37 percent of early morning patients, and 28 percent of those got a sigmoidoscopy, colonoscopy or fecal occult blood test within the year.
Only 23 percent of early evening patients, however, were sent for screenings, and just 18 percent followed through.
After lunch breaks, the study authors saw a brief spike in the proportion of patients sent for screenings, but then the food comas and late afternoon dragged on, rates fell again.
Screening is life-saving.
In colon cancer, for example, precancerous growths, or polyps, can be removed during the course of a screening (via colonoscopy).
The National Institutes of Health has credited screening for cutting the death rate from colorectal cancer by up to a half.
But some of those lives might not be saved if their doctors don’t send them for screening because they’re rushing through end-of-day appointments.
The researchers call it ‘decision fatigue.’
‘People may be less inclined to consider a new decision after they’ve been making them all day,’ said lead author Esther Hsiang, a researcher and graduate student at the University of Pennsylvania.
‘It may also stem from overloaded clinicians getting behind as the day progresses.’
There’s only so much that can be done to keep doctors from getting tired, but the study authors suggest that technology can help.
‘In past work, we’ve found that nudges in the electronic health record can be used to address these types of gaps in care, which we suspect will be the case here,’ said Dr Mitesh Patel, a professor at Penn Medicine.
‘Future research could evaluate how nudges may be implemented in order to improve cancer screening.’
