A study led by University of Pennsylvania Assistant Professor Mitesh Patel that found physicians’ likelihood of referring patients for cancer screenings changes according to the time of day is the subject of a lengthy article in AAFP News.

AAFP News is the national online publication of the American Academy of Family Physicians. Patel, MD, MBA, a faculty member in both the Perelman School of Medicine and the Wharton School of Business, is also the Director of the Penn Medicine Nudge Unit and a member of the Advisory Group of the Penn Center for Cancer Care Innovation (PC3I).

Patients from 33 practices
Using 2014-to-2016 patient visit data from 33 family medicine and internal medicine practices in Pennsylvania and New Jersey, the Penn researchers found the highest numbers of breast cancer screening referrals for eligible patients occurred during the first hour of patient visits. Referrals decreased substantially throughout the morning but rebounded at noon before declining again throughout the afternoon.

In an interview with AAFP News, Patel cited decision fatigue and said “Physicians are increasingly being asked to do more with the same or less amount of time, and this pattern needs to change to address the issues our study found.”

“Just being aware that (decision fatigue) affects everyone as the day progresses is important,” Patel told AAFP. He recommended setting aside time for short breaks during the day as a way to address the problem.

He also pointed out that another cause of the variation is the patient haste. He said many who have afternoon appointments decline to discuss cancer screening because of a desire to conclude the visit as quickly as possible and return to their work or other activities.

Published in JAMA Network Open, the original study was entitled “Association of Primary Care Clinic Appointment Time With Clinician Ordering and Patient Completion of Breast and Colorectal Cancer Screening.”