EHR integrated comprehensive distress screening: Patterns of automated referrals to oncology supportive services (at a large health system).

332 Background: Systematic distress screening in ambulatory oncology is essential, yet many cancer patients’ social drivers of health (SDOH) needs and psychosocial distress remain unrecognized. This study evaluates the demographic, clinical, and referral pattern outcomes of an automated screening and referral system to social work (SW) across 8 ambulatory oncology sites. Methods: The Quality of Life and Support (QOLS) survey integrates evidence-based SDOH and mood-related questions into the electronic health record, Epic. Patients complete the survey at their 2 nd medical oncology appointment and every 6 months thereafter. Reported needs prompt automatic referrals to SW (i.e., transportation, finances, depressive symptoms (PHQ-2), patient self-referral, etc); spiritual care (i.e., experienced loss of meaning, religious or spiritual struggles, or requested spiritual support); and/or family care (i.e., self-referral). We conducted a retrospective analysis of surveys completed June 2022 to March 2025. Descriptive statistics compared patients referred to SW with those not referred. Results: 13,594 patients completed 30,240 QOLS surveys. 17.5% (n = 5,278) of surveys, completed by 2,263 patients led to SW referral. Surveys were most often referred to SW due to self-referral (58%), followed by PHQ8 (27%), and then transportation (24%). 681 (5%) of surveys were referred for more than one reason. Non-white male patients, and those with GI and hematological cancers were more likely to escalate to SW. Conclusions: Integration of the QOLS survey into routine oncology care effectively identified patients with unmet social, emotional, and spiritual needs. Automated referral pathways facilitated timely connection to supportive services, with disparities observed by race, gender, insurance, and cancer type. The observed patterns highlight critical opportunities to tailor screening thresholds and outreach strategies for vulnerable subgroups. These findings support the value of EHR-embedded screening tools in addressing holistic patient care in oncology. Characteristics of patients who did and did not escalate to SW. No SW escalationn=11,331 (83%) SW escalationn=2,263 (17%) Race*African-American 2121 (19) 692 (31) Asian 1010 (9) 162 (7) Blank/unknown 344 (3) 70 (3) Other/ Patient declined 2200 (19) 632 (28) White 5656 (50) 707 (31) Payor*Medicaid 1365 (12) 549 (24) Medicare 4447 (39) 967 (43) Private 5519 (49) 747 (33)