Table 2.

Themes and Representative Quotes of Participants' Goals for Implementation of Distress Screening

Theme	No Experience	Experience in One Clinic or Patient Population	Experience in ≥ Two Clinics or Patient Populations
Creating buy-in
Engendering support among key stakeholders	“Recruit a distress screening steering committee, including representatives from social work, nursing, physicians, and administration.”	“Attend radiation oncology operational meetings to discuss and educate staff regarding the importance of screening and follow up with staff regarding any difficulties.”	“Use in-services to increase staff's knowledge of psychosocial oncology and use of strategies to address patient distress.”
Deciding/developing specifics
Deciding on specifics of five steps of distress screening and developing implementation systems
Step one: brief screening	“Conduct a literature review to identify the best distress screening tool for our clinical setting.”	“Compare the NCCN Distress Thermometer problem list to the current nursing review of systems/symptoms form and remove areas of duplication from the problem list.”	“Review existing measures for comprehensive wellness assessment with professionals offering supportive care.”
	“Connect with coordinators … to identify time to administer the tool.”	“Choose a pivotal time for distress screen reassessment.”
Step two: clinical assessment		“Patients [who screened positive for distress] will be followed up within 48 hours by a member of the psychosocial support team.”
Step three: referral network	“Create a list of current psychosocial healthcare services provided by our behavioral health department.	“Create an electronic community referral database and make it available to staff on the shared drive and to patients via a Web-based education portal.”	“To develop a referral and resource network based on specific needs identified in screening, both at the institution and in the community.”
Step four: follow-up		“The clinical psychologist or oncology nurse manager will report back to referring provider of the outcome of the distress management.”
Step five: documentation/quality improvement	“Complete baseline audit of 50 new patients (breast, lung, and colon cancer clinics) to identify frequency of distress screening, referral for psychosocial support and follow-up.”	“All newly diagnosed cancer patients will be invited to participate in a phone survey at two time points (ie, three months after initial distress screening and one year post diagnosis) to solicit feedback regarding the distress screening process.”
Piloting/beginning
Taking steps to implement distress screening elements for first time or in new clinic or patient population	“Complete pilot distress screening of 250 patients and survey seven participating providers. Present findings to stakeholder.”		“To begin screening all patients entering a clinical trial.”