Implementation of a universal psychosocial screening program across the pediatric cancer treatment trajectory: a standard of care

PURPOSE: Guided by Rapid Evaluation and Assessment Methods (REAM) and using rigorous quality improvement processes, we describe implementation of an evidence-based psychosocial screening program at key transitions in childhood cancer treatment to guide care matched to need. METHODS: Pediatric cancer patients (≥ 11 years) and caregivers (patients 0-17 years) were offered screening questionnaires electronically at 4-6 months, 18-24 months, and 4-6 years post-diagnosis through a phased implementation across three cancer center sites and in their preferred language (English, Spanish, Arabic). Screening questionnaires assessed cancer-related symptoms, health-related quality of life, cognitive function and school needs, caregiver adjustment and family risk, and resource needs. To assess adoption, feasibility, penetration, and sustainability, data related to screening processes, documentation completion rates, and adaptations were tracked and summarized. Qualitative interviews with patients, caregivers, and clinicians, based on the Consolidated Framework for Intervention Research (CFIR), were coded for acceptability and screening program optimization. RESULTS: Across sites and timepoints, from June 2023 through November 2025, there was a 56% screening completion rate (470/846). Patient physical functioning, emotional functioning, and neurocognitive functioning, caregiver adjustment, and resource needs were consistently flagged for follow-up. Documentation of follow-up varied with rates of 74% for social workers and 34% for medical clinicians. Patients, caregivers, and clinicians endorsed moderate acceptability. Barriers to electronic health record integration complicated clinician workflows. From initiation, over 2 years, 55 adaptations were made to improve workflow, implementation strategies, screening processes, and measures. CONCLUSION: We achieved development, implementation, and optimization of a psychosocial screening program across our cancer center.