{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T09:23:52Z","timestamp":1778923432276,"version":"3.51.4"},"reference-count":57,"publisher":"Wiley","issue":"18","license":[{"start":{"date-parts":[[2021,5,27]],"date-time":"2021-05-27T00:00:00Z","timestamp":1622073600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["K07CA230150"],"award-info":[{"award-number":["K07CA230150"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["K08CA234431"],"award-info":[{"award-number":["K08CA234431"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["P30CA042014"],"award-info":[{"award-number":["P30CA042014"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2021,9,15]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Low\u2010value prostate\u2010specific antigen (PSA) testing is common yet contributes substantial waste and downstream patient harm. Decision fatigue may represent an actionable target to reduce low\u2010value urologic care. The objective of this study was to determine whether low\u2010value PSA testing patterns by outpatient clinicians are consistent with decision fatigue.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Outpatient appointments for adult men without prostate cancer were identified at a large academic health system from 2011 through 2018. The authors assessed the association of appointment time with the likelihood of PSA testing, stratified by patient age and appropriateness of testing based on clinical guidelines. Appointments included those scheduled between 8:00\u00a0<jats:sc>am<\/jats:sc> and 4:59\u00a0<jats:sc>pm<\/jats:sc>, with noon omitted. Urologists were examined separately from other clinicians.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In 1,581,826 outpatient appointments identified, the median patient age was 54\u00a0years (interquartile range, 37\u201066\u00a0years), 1,256,152 participants (79.4%) were White, and 133,693 (8.5%) had family history of prostate cancer. PSA testing would have been appropriate in 36.8% of appointments. Clinicians ordered testing in 3.6% of appropriate appointments and in 1.8% of low\u2010value appointments. Appropriate testing was most likely at 8:00\u00a0<jats:sc>am<\/jats:sc> (reference group). PSA testing declined through 11:00\u00a0<jats:sc>am<\/jats:sc> (odds ratio [OR], 0.57; 95% CI, 0.50\u20100.64) and remained depressed through 4:00\u00a0<jats:sc>pm<\/jats:sc> (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001). Low\u2010value testing was overall less likely (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001) and followed a similar trend, declining steadily from 8:00\u00a0<jats:sc>am<\/jats:sc> (OR, 0.48; 95% CI, 0.42\u20100.56) through 4:00\u00a0<jats:sc>pm<\/jats:sc> (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001; OR, 0.23; 95% CI, 0.18\u20100.30). Testing patterns in urologists were noticeably different.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Among most clinicians, outpatient PSA testing behaviors appear to be consistent with decision fatigue. These findings establish decision fatigue as a promising, actionable target for reducing wasteful and low\u2010value practices in routine urologic care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Lay Summary<\/jats:title><jats:p>\n<jats:list list-type=\"bullet\">\n\n<jats:list-item><jats:p>Decision fatigue causes poorer choices to be made with repetitive decision making.<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>This study used medical records to investigate whether decision fatigue influenced clinicians' likelihood of ordering a low\u2010value screening test (prostate\u2010specific antigen [PSA]) for prostate cancer.<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>In more than 1.5 million outpatient appointments by adult men without prostate cancer, the chances of both appropriate and low\u2010value PSA testing declined as the clinic day progressed, with a larger decline for appropriate testing.<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>Testing patterns in urologists were different from those reported by other clinicians.<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>The authors conclude that outpatient PSA testing behaviors appear to be consistent with decision fatigue among most clinicians, and interventions may reduce wasteful testing and downstream patient harms.<\/jats:p><\/jats:list-item>\n<\/jats:list>\n<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.33644","type":"journal-article","created":{"date-parts":[[2021,5,27]],"date-time":"2021-05-27T17:07:54Z","timestamp":1622135274000},"page":"3343-3353","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Decision fatigue in low\u2010value prostate cancer screening"],"prefix":"10.1002","volume":"127","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2439-7578","authenticated-orcid":false,"given":"Trevor C.","family":"Hunt","sequence":"first","affiliation":[{"name":"Division of Urology Department of 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