Time of day associated with ordering, completion of cancer screening

An editorial noted that referrals to screening could be handled by other clinic staff, easing the burden on physicians.

Patients with primary care clinic appointment times later in the day were less likely to receive recommendations for cancer screening, a study found.

To evaluate the association of primary care clinic appointment time with clinician ordering and patient completion of breast and colorectal cancer screening, researchers conducted a retrospective study of 33 primary care practices in Pennsylvania and New Jersey from September 2014 to August 2016. The researchers recorded the time of the physician visit and whether the patient had completed the screening at one year. Results were published May 10 by JAMA Network Open.

Among the 19,254 patients eligible for breast cancer screening, order rates were highest for visits at 8 a.m. at 63.7%, decreased throughout the morning to 48.7% at 11 a.m., increased to 56.2% at noon, and then decreased to 47.8% at 5 p.m. (adjusted odds ratio [OR] for overall trend, 0.94; 95% CI, 0.93 to 0.96; P<0.001). Trends in screening test completion were similar, decreasing from 33.2% at 8 a.m. to 17.8% at 5 p.m. (adjusted OR, 0.95; 95% CI, 0.94 to 0.97; P<0.001).

Among the 33,468 patients eligible for colorectal cancer screening, order rates were 36.5% at 8 a.m., decreased to 31.3% by 11 a.m., increased at noon to 34.4%, and then decreased to 23.4% at 5 p.m. (adjusted OR, 0.94; 95% CI, 0.93 to 0.95; P<0.001). Trends in screening completion were similar, decreasing from 28.0% at 8 a.m. to 17.8% at 5 p.m. (adjusted OR, 0.97; 95% CI, 0.96 to 0.98; P<0.001).

“As each shift progresses, clinicians may fall behind schedule. The tendency may lead to shorter interactions with the patient at the end of the morning and afternoon shifts. In these situations, cancer screening may not be discussed or may be deferred to the future,” the study authors said.

An editorial noted that acute care needs such as respiratory tract infections or back pain require the presence of clinician and patient, while recommendations for preventive services generally do not.

“Many high-performing cancer screening interventions are delivered by nonclinician members of the care team, including proactive efforts to address screening gaps before office visits as well as mail- or phone-based outreach for patients due for screening,” the editorial stated. “In addition to being an effective preventive approach, population-based screening efforts should decrease the amount of face-to-face work, freeing clinicians to devote greater attention to patients' short- and long-term needs.”