Colorectal Cancer Coverage from Every Angle

Does Primary Care Appointment Time Affect Colorectal Cancer Screening Rates?

By: Kayci Reyer
Posted: Thursday, August 1, 2019

According to research published in JAMA Network Open, primary care clinicians were less likely to order or complete guideline-recommended colorectal cancer screenings for patients with appointments occurring later in the day. In addition, patients with later appointment times were less likely to have completed the recommended screening within 1 year of the visit.

“We believe that the downward trend of ordering may be the result of ‘decision fatigue,’ where people may be less inclined to consider a new decision after they’ve been making them all day,” noted initial study author Esther Y. Hsiang, BA, of the University of Pennsylvania in a press release from Penn Medicine. “It may also stem from overloaded clinicians getting behind as the day progresses.” Mitesh S. Patel, MD, MBA, MS, also of the University of Pennsylvania, is the senior study author.

The retrospective, multicenter study included 33,468 patients eligible for colorectal cancer screening between September 1, 2014, and August 31, 2016. Participants with appointment times at noon or earlier experienced a significantly higher cancer screening order rate than patients with late-afternoon appointments. Morning order rates were 36.5% at 8:00 AM, 31.3% at 11:00 AM, and 34.4% at noon, whereas order rates at 5:00 PM were down to 23.4% (adjusted odds ratio = 0.94; P < .001). Screening test completion rates saw a similar decline, starting at 28.0% at 8:00 AM and falling to 17.8% at 5:00 PM (adjusted OR = 0.97; P < .001).

For this study, the mean patient age was 59.6 years. A total of 18,672 patients (55.8%) were women. Among study participants, 22,157 (66.2%) were white, and 7,296 patients (21.8%) were black. The study also investigated the effect of appointment times on screenings for breast cancer using a separate patient pool.

Disclosure: The study authors’ disclosure information may be found at

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