Implementing systematic distress screening in veteran oncology care: a quality improvement initiative

Distress is common among patients with cancer and is associated with worse outcomes yet routine distress screening remains inconsistently implemented in outpatient oncology clinics, particularly for Veterans. We conducted a quality improvement project (QIP) in the surgical oncology clinic at a large Veterans Affairs medical centre to improve distress screening among Veterans with newly diagnosed cancer. A multidisciplinary team designed and implemented a comprehensive psychosocial distress screening programme using the validated NCCN Distress Thermometer. Key drivers of screening reliability were identified through stakeholder interviews and used to guide intervention design. The intervention incorporated standardised screening, evaluation of positive screens, predefined referral pathways, timely follow-up with embedded mental health services and structured electronic record documentation. The programme was iteratively refined through Plan–Do–Study–Act cycles. A total of 178 veterans were included over a 6-month baseline period and 12 months of intervention. During the baseline phase, only 5% of eligible veterans had documented distress screening. Following implementation, screening rates increased from 5% at baseline to 87% by the end of the intervention period. 27 of 117 veterans (23.1%) screened positive for distress during the intervention period. 18 accepted referrals to mental health services, four were already established with mental healthcare and five declined referral. Veterans requiring urgent evaluation were seen by mental health services the same day or the following day, while all remaining veterans accepting referral were scheduled within 2–3 weeks. This project demonstrates that systematic distress screening for veterans with cancer can be successfully embedded into routine outpatient oncology care. Pairing standardised workflows with integrated referral pathways, timely follow-up and electronic health record documentation provides a scalable and sustainable model for comprehensive psychosocial distress screening in veteran oncology care.