Your chances of getting screened for cancer depend a lot on whether you visit your doctor bright and early in the morning or in the afternoon, a new study suggests.
When patients were eligible for breast cancer screenings, primary care physicians ordered the measure for 64% of them during the 8 a.m. hour. But during the 5 p.m. hour, those same doctors started arranging tests for 48% of their eligible patients, according to University of Pennsylvania researchers.
The same decline happened with colon cancer screenings — doctors ordered the tests for 37% of the 8 a.m. patients, but 23% of the 5 p.m. patients received the same thing.
The screening order drop-off could be linked to “decision fatigue,” the mental burn-out that makes it harder for people to think through big decisions the farther they get into the day, said the JAMA Network Open study. The decline also could stem from doctors running behind on their appointments, the researchers acknowledge.
‘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.’ — Newly released University of Pennsylvania study
“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,” the study said. Another possibility was that “patients who see their clinician later in the day want to leave sooner and decline a discussion about cancer screening,” researchers added.
In a grim twist, it seems the end of the day also affects patients. As doctors ordered fewer screenings later, the people on the receiving end of those orders completed the tests at a lower rate. Their own screening test completion rates — which involve scheduling tests with specialists — were lower.
There was sort of midday bright spot as doctors caught up during lunch. Though breast cancer screenings fell to 48.7% at 11 a.m., they climbed up to 56.2% at noon. But then the rates fell again.
The study is a sobering look at decision fatigue, a phenomenon studied in all sorts of contexts, like water polo players, video streaming tendencies and parole decisions happening to occur in the afternoon.
On the flip side, there’s long been plenty of talk about managing decision fatigue and “winning the morning to win the day” in order to maximize productivity.
Don’t Miss: How Artificial Intelligence could help with early detection of breast cancer
For example, Colin Powell, the decorated generatl and former Secretary of State, might’ve been getting at the significance of evaluating situations with fresh eyes at the day’s start with the first of his 13 rules on leadership: “It ain’t as bad as you think. It will look better in the morning.”
The newly-released study is also a reminder that for all of modern medicine’s technological advances, there’s still a human element that doesn’t make the best care a guarantee.
For example, another study showed that patients admitted to hospitals around the holiday season had increased risks of death or readmission. One of the reasons was that many doctors themselves were out of town, celebrating the holidays.
Researchers at the university’s Perelman School of Medicine and the Wharton School sifted through two years of data from 33 primary care practices in New Jersey and Pennsylvania, with around 19,000 patients eligible for breast cancer screenings and 33,000 patients eligible for colorectal cancer screenings.
Almost 600,000 Americans died from cancer in 2016, according to the Centers for Disease Control and Prevention.
The stakes are high. Almost 600,000 Americans died from cancer in 2016, second to heart disease, which caused 635,260 deaths that year, according to the Centers for Disease Control and Prevention.
Past research by the same study team spotted waning flu vaccination rates at the day went on, going from about 44% to 32%.
To fix the issue, “nudges” were tacked onto the system asking whether doctors wanted to accept or decline an order for a flu shot. Doctors with the nudges prescribed flu shots at increased rates compared to doctors without the reminders.
Dr. Mitesh Patel, the director of the Penn Medicine Nudge Unit and an assistant professor of Medicine, said, “Our new study adds to the growing evidence that time of day and decision fatigue impacts patient care. 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.”
Get a daily roundup of the top reads in personal finance delivered to your inbox. Subscribe to MarketWatch's free Personal Finance Daily newsletter. Sign up here.
