The Implementation of a Caregiver Distress Screening Initiative in a Pediatric Oncology Healthcare Setting: A Quality Improvement Project

Background: Parents of children with cancer often experience significant stressors that can heighten distress and impact overall well-being. Despite recommendations supporting distress screening for adult and pediatric patients with cancer, systematic assessment of parent or caregiver distress in pediatric oncology settings remains limited. This Quality Improvement initiative aimed to implement routine distress screening for adult caregivers of pediatric patients with brain and solid tumors at our institution. Methods: Using the 18-item CancerSupportSource™-Caregiver (CSS-CG) instrument, our social work team invited eligible caregivers to complete monthly electronic distress screeners while their child was receiving treatment. Automated reports with tailored psychoeducational resources were sent to caregivers upon completion, and social workers received alerts when participants scored at-risk for anxiety, depression, or financial strain. The feasibility of the CSS-CG implementation was assessed via caregiver enrollment and completion rates, and clinician acceptability was evaluated through a post-implementation survey. Results: Of 122 eligible patients, 64 of their caregivers enrolled in the CSS-CG screening platform (52.45%), and 44 (36.06%) completed at least one screener. Of the 44 caregivers who completed the CSS-CG assessment, 59.09% (n = 26) screened positive at least once for risk of anxiety, 54.54% (n = 24) for risk of financial strain, and 59.09% (n = 26) for risk of depression. Among participating social workers, 83% reported that the screener improved their clinical practice, making their sessions more focused and helpful. They also noted that it improved their ability to identify a caregiver’s overall needs. Conclusions: Implementing caregiver distress screening positively impacted social work practice at our institution. Despite variable caregiver enrollment and a few implementation challenges, the findings support the importance and potential benefit of screening for caregiver distress in a pediatric oncology setting.