Researchers from Johns Hopkins University and the University of Pennsylvania recently asked, “Are breast and colorectal cancer screening rates associated with the time of day a patient visits the primary care clinician?” To find out, they conducted an analysis of over 50,000 electronic health records for patients in 33 primary care practice sites. The analysis concluded that “patients with primary care clinic appointment times later in the day were less likely to be ordered for and receive guideline-recommended cancer screening.”
The study, published in JAMA Oncology, found the decrease in screening rates were “most notable” toward the end of the morning and afternoon shifts, possibly as a result of scheduling or fatigue. When physicians fall behind, say researchers, they may tend toward “shorter interactions with the patient” causing the discussion of cancer screening to be “deferred to the future.” Later in the day, physicians may also “face decision fatigue” or be “less likely to discuss cancer screening with patients simply because they have already done this (and made other decisions) a number of times.”
In addition, the study indicated that patients seen in the afternoon were less likely to complete cancer screenings within one year of the visit. This finding demonstrates how “decisions made during a single PCP visit may have a lasting effect on patient behavior. 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.”
The researchers say more work is needed to understand the behaviors of both physicians and patients, “as well as other factors associated with patient completion of screening tests.” However, as reported in Fierce Healthcare, there’s value in “considering how the timing of physician visits might influence both physician and patient behavior when it comes to cancer screening.”
MLMIC encourages policyholders to be vigilant in cancer screening for the health and well-being of their patients. Providers should also be aware that the failure to diagnose and a delay in diagnosis of cancer continue to be leading causes of malpractice litigation for MLMIC policyholders.