Implementation of a Universal Psychosocial Screening Program Across the Pediatric Cancer Treatment Trajectory: A Standard of Care

Implementation of a Universal Psychosocial Screening Program Across the Pediatric Cancer Treatment Trajectory: A Standard of Care | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Implementation of a Universal Psychosocial Screening Program Across the Pediatric Cancer Treatment Trajectory: A Standard of Care Lamia P. Barakat, Susanna Vargo, Shannon N. Hammer, Anne Reilly, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9202191/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract 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. Childhood Cancer Health Equity Implementation Science Psychosocial Screening Psychosocial Standards of Care Survivorship Figures Figure 1 Figure 2 Introduction The diagnosis and treatment of pediatric cancer adversely affect multiple levels of a family’s social ecology, including patient and caregiver physical and psychosocial health. 1 Families with limited instrumental and social resources and pre-existing child and family problems are particularly at risk for health disparities and challenges traversing childhood cancer care. 2 As such, there is recognition of the importance of evidence-based psychosocial care for children with cancer and their families for facilitating adjustment through consistent access to and engagement in care matched to needs. 3 – 5 The 2015 Institute of Medicine Report and the Standards of Psychosocial Care in Childhood Cancer call for improvement in delivery of psychosocial care. 1 , 3 Unfortunately, few children’s cancer programs offer care consistent with the Standards in a universal, systematic manner, highlighting critical gaps that can limit medical and psychosocial outcomes and magnify health disparities. 3 , 5 This project addresses the call to translate the Standards into clinical care by focusing on implementing the First Standard, Youth with cancer and their family members should routinely receive systematic assessments of their psychosocial health care needs , 6 and expanding to related Standards of neuropsychological assessment (Standard 2), 7 assessment of financial needs (Standard 5), 8 and psychosocial care for parents (Standard 6). 9 The First Standard emphasizes the role of psychosocial screening with patient- and caregiver-reported outcome measures at diagnosis and treatment transitions. 6 , 10 , 11 Universal screening facilitates early identification of psychosocial risks, initiates preventive interventions to support long-term health-related quality of life, promotes access to targeted, evidence-based care matched to need, reduces implicit bias inherent in non-systematic assessment, and supports equitable, cost-effective integrated psychosocial services. 12 , 13 Further, psychosocial screening at key treatment transitions (e.g., end of active treatment) allows clinicians to assess emerging or persistent patient and caregiver challenges and to adjust care to promote post-treatment adjustment and continued engagement in care. 10 , 11 The Standards have set expectations for psychosocial care across children’s cancer programs, but implementation has been inconsistent due to barriers at the patient/caregiver, clinician, programmatic, and institutional levels. 5 , 14 Facilitators of care consistent with the Standards have been identified, and there is value in understanding how to leverage implementation strategies in clinical care to support adoption of screening. Evidence suggests screening is acceptable to patients and caregivers, and feasible to implement in clinical care. However, clinicians are concerned with potential challenges in clinic workflow, time and effort required to screen and respond to screening, and costs of meeting identified needs. 15 At the institutional level, it is important to identify screening champions and ensure funding for psychosocial programs that include screening. For example, a recent study suggests few programs view themselves as sufficiently staffed to provide services consistent with the Standards, and financial considerations are noted as a barrier to staffing. 5 Also, there was limited growth in psychosocial programs over a 10-year period. 5 Taken together, attention to barriers and facilitators is critical to successful implementation of care consistent with the Standards. 3 Building from prior studies in our children’s cancer program, 11,12,14,16–18 we designed a universal psychosocial screening program with patient- and caregiver-reported outcome measures at three timepoints in the cancer treatment trajectory. The program was implemented, evaluated, and modified in phases across three Children’s Hospital of Philadelphia (CHOP) Cancer Center disease groups, sites, and screening languages. Implementation strategies were integrated into clinical care, evaluated after each phase, and modified based on ongoing evaluation. Implementation outcomes are described: (1) adoption (patient and caregiver completion of surveys), (2) feasibility (communication of results to clinicians), (3) penetration (clinician documentation of discussion of screening results with patients/caregivers), and (4) modifications for sustainability were informed by patient and caregiver acceptability ratings and qualitative feedback from patients, caregivers, and clinicians. We also present adaptations , or iterative modifications to address identified barriers and promote sustainability of the screening program. Methods This quality improvement project was conducted at the CHOP Cancer Center. We utilized a multi-phased approach to implement psychosocial screening (Fig. 1 ) across its disease groups (Hematologic Malignancies, Solid Tumors, Brain Tumors), sites (Main Hospital in Philadelphia, PA and Specialty Care Centers in King of Prussia, PA and Voorhees, NJ), and most commonly used languages in our center (English, Spanish, Arabic). Institutional Review Board approval allowed for dissemination (CHOP IRB 24-022574). Clinical trial number: not applicable. Rapid Evaluation and Assessment Methods (REAM), 19,20 guidelines for gathering reliable information on the current services for efficient integration into health care systems and improved responsiveness, patient/caregiver/clinician satisfaction, and service delivery, informed pre-implementation planning and implementation and evaluation. Using REAM, 19,20 iterative modifications and/or enhancements (“adaptations”) to the screening program and its implementation were made based on continuous review of outcomes at each implementation phase, and discussion among the screening team, working group members, and relevant clinicians. Pre-implementation Planning Interdisciplinary Workgroup . In late 2021, the screening team formed an interdisciplinary workgroup of CHOP Cancer Center staff (n = 10; pediatric psychology, neuropsychology, social work, child life, hospital school program, nursing) and pediatric patient/caregiver community members (n = 2) to begin planning a screening program within routine clinical care. The working group appraised the literature review on screening, prepared an institutional assessment of current practice, identified implementation strategies, and provided input throughout planning and preparation. Institutional Assessment . Existing screening processes were assessed via REDCap 21 survey of 13 clinicians involved in psychosocial assessments in our cancer program, in accordance with published recommendations for implementing the Psychosocial Standards of Care. 22 Results indicated psychosocial screening was semi-structured and primarily occurred immediately following diagnosis or as needed. Evidence-based, psychometrically-sound, patient-reported outcome measures were not integrated into screening. Although screening was documented in the electronic health record (EHR), documentation was not templated. We also identified the need for a blueprint to guide the team in systematically matching resources to needs and coordinating multidisciplinary follow-up. Key elements of screening program . Next, core components were determined: timing, patient- and caregiver-reported outcome priorities/domains to impact care (Table 1 ), and guidance on addressing needs identified through screening (Table 2 ). A plan for communication with patients, caregivers, and clinicians via the EHR was developed for clinical integration of screening data and documentation of follow-up along with related workflows. Full EHR integration did not allow for comprehensive screening and potential changes in measures, screening processes, and expansion; therefore, we proceeded with screening via REDCap 21 and communication and documentation via the EHR. Table 1 Oncology Psychosocial Screening Program Elements Why? To enhance clinical care, address health inequities in pediatric cancer, identify areas of risk and resilience, and facilitate timely and targeted assessment/intervention. Who? Population : Patients (≥ 11 years) and Caregivers (of patients 0–17 years) in the CHOP Cancer Center Service : Hematologic Malignancies, Solid Tumors, Brain Tumors Language : English, Spanish, Arabic What? Screening Domains Cancer-Related Symptoms Medication Management Physical Quality of Life Social Quality of Life Emotional Functioning Neurocognitive Functioning Caregiver Adjustment Family Factors Resource Needs Where? Screening Sites Philadelphia, PA Main Hospital King of Prussia, PA Specialty Care Voorhees, NJ Specialty Care When? Screening Timepoints Initial Diagnosis (4–6 months post-diagnosis) Short-Term Follow-Up (18–24 months post-diagnosis) Long-Term Follow-Up (4–6 years post diagnosis/survivorship) How? Screening Process — Screening surveys were delivered to patients and caregivers via a MyChart message with a REDCap 21 link and completed remotely or in clinic. — Screening results were shared in an EHR Care Coordination note routed to oncology clinicians and social workers prior to the patient’s clinic appointment. Abbreviations : CHOP (Children’s Hospital of Philadelphia), EHR (Electronic Health Record) Table 2 Measures with Clinical Cutoffs indicating Needs Follow-Up Domain Measure Risk Score (Flagged for Follow-Up) Reporter (PT age) Timepoint PT CGR Self Proxy Self Cancer-Related Symptoms (+) SSPedi a [≥ 1 Symptom = 4 or 5] a ≥ 11 0–17 - ID, SF Medication Management PROMIS: Self-Efficacy–Managing Med b T-Score < 40 ≥ 18 - - ID, SF, LF Physical Quality of Life PedsQL: Physical Functioning c Scale Score < 65 - 2–4 - ID, SF, LF PROMIS: Physical Function Mobility d T-Score < 40 11–17 5–17 ID, SF, LF PROMIS: Physical Function e T-Score 55, c 60 d ≥ 11 5–17 - ID, SF, LF PROMIS: Pain Interference d,e T-Score > 55, c 60 d ≥ 11 5–17 - ID, SF, LF (+) PROMIS: Sleep Disturbance e,f T-Score > 60, e,f 59 g ≥ 11 5–17 - ID, SF, LF (-) PROMIS: Physical Activity g T-Score < 40 ≥ 11 5–17 - ID, SF, LF Social Quality of Life PedsQL: Social Functioning c Scale Score < 65 - 2–4 - ID, SF, LF PROMIS: Peer Relationships d T-Score < 40 11–17 5–17 - ID, SF, LF PROMIS: Social Roles/Activities e T-Score < 40 ≥ 18 - - ID, SF, LF Emotional Functioning PedsQL: Emotional Functioning c Scale Score 55, c 60 d ≥ 11 5–17 - ID, SF, LF PROMIS: Depressive Symptoms d T-Score > 55 11–17 5–17 - ID, SF, LF PROMIS: Depression e T-Score > 60 ≥ 18 - - ID, SF, LF NCCN Distress Thermometer h Rating ≥ 4 ≥ 11 0–17 ID, SF, LF PAT: Patient Problems i Scale Score ≥ 0.50 - 0–17 - ID, SF, LF Neurocognitive Functioning PedsQL: School Functioning c Scale Score < 65 - 2–4 - ID, SF, LF SCQ j Item 1 = 0 or Item 2 = 1 k ≥ 18 0–17 - ID, SF, LF CLDQ: Reading, Math k ≥ 2.67, 2.60 - 5–17 - ID, SF, LF (-) PRISM l ≥ 1 - 5–17 - ID, SF PROMIS: Cognitive Function m T-Score < 40 ≥ 11 8–17 - ID, SF Caregiver Adjustment PAT: Stress Reaction i Scale Score ≥ 0.50 - - 0–17 ID, SF, LF PAT: Family Beliefs i Scale Score ≥ 0.50 - - 0–17 ID, SF, LF NCCN Distress Thermometer h Rating ≥ 4 - - 0–17 ID, SF, LF Family Factors PAT: Family Problems i Scale Score ≥ 0.50 - - 0–17 ID, SF, LF PAT: Sibling Problems i Scale Score ≥ 0.50 - - 0–17 ID, SF, LF Resources PAT: Social Support i Scale Score ≥ 0.50 - - 0–17 ID, SF, LF PAT: Transit/Money Problems n If ≥ 1 Problem Endorsed - - 0–17 ID, SF, LF NCCN Problem List: Practical Concerns h If ≥ 1 Concern Endorsed ≥ 18 - - ID, SF, LF Abbreviations : PT (Patient) , CGR (Caregiver) , ID (initial diagnosis, 4–6 months post-diagnosis) , SF (short-term follow-up, 18–24 months post-diagnosis) , LF (long-term follow-up, 4–6 years post-diagnosis/survivorship) , (+) measure added via adaptation; (-) measure removed via adaptation. Measures : a Symptom Screening in Pediatrics [Flagged for Follow-Up if ≥ 1 symptom was rated as bothering patient ‘A lot’ (4) or ‘Extremely’ (5)] 26 b PROMIS Short Form v1.0 – Self-Efficacy for Managing Medications and Treatment 8a) 36 c Pediatric Quality of Life Inventory v4.0 – Parent Report for Toddlers [ages 2–4] 37 d PROMIS Pediatric-25 Profile v2.0 (Patients 11–17); PROMIS Parent Proxy-25 Profile v2.0 (Proxy 5–17) 38 e PROMIS-29 Profile v2.1 (Patients ≥ 18) 39 f PROMIS Pediatric Short Form v1.0 – Sleep Disturbance 4a (Patients 11–17); PROMIS Parent Proxy Short Form v1.0 – Sleep Disturbance 4a (Proxy 5–17) 38 , 39 g PROMIS Pediatric Short Form v1.0 – Physical Activity 4a (Patients ≥ 11); PROMIS Parent Proxy Short Form v1.0 – Physical Activity 4a (Proxy 5–17) 40 h National Comprehensive Cancer Network v1.2022 – Distress Management 41 i Psychosocial Assessment Tool (adapted all-literacy–all ages version, 2019) 16 j School Concern Questionnaire [Flagged for Follow-Up if Item 1: “My child is currently meeting their academic potential” = ‘No’ (0) or Item 2: “My child needs more educational support to be successful” = ‘Yes’ (1)] 42 k Colorado Learning Difficulties Questionnaire 43 l Problem Recognition in Illness Self-Management 44 m PROMIS Pediatric Short Form v1.0 – Cognitive Function 7a (Patients 11–17); 36 PROMIS Parent Proxy Short Form v1.0 – Cognitive Function 7a (Proxy 8–17); 36 PROMIS Short Form v2.0 – Cognitive Function 8a (Patients ≥ 18) 38,39 n Two items ( “How will you or other caregivers get to the hospital of clinic?” and “In what areas are there money problems?”) from the PAT: Structure/Resources scale 16 Patient population . Patients were identified via an EHR report based on cancer date of diagnosis and filtered by screening timepoints: 4–6 months post-diagnosis (Initial Diagnosis), 18–24 months post-diagnosis (Short-Term Follow-Up), and 4–6 years post-diagnosis (Long-Term Follow-Up) and preferred language (English, Spanish, Arabic, Other). Patients aged ≥ 11 years and caregivers of patients 0–17 years were invited to complete surveys via an EHR patient portal message (MyChart) one week prior to a scheduled outpatient appointment falling within the relevant screening window. Patients completed self-report measures, and Caregivers completed self- and proxy-report measures. Surveys were distributed at each timepoint regardless of completion at prior timepoints. Screening measures . Measures were selected based on review of the literature, 6 feedback from our interdisciplinary workgroup and community partners about priorities for assessment, consideration of patient/caregiver burden, appropriateness for the age groups, utility in childhood cancer populations, and actionability of response to identified needs (Table 2 ). For each measure, validation-based cut-points were used to determine results warranting follow-up. Screening documentation . A templated care coordination note was developed to route screening results to the medical clinician scheduled for the patient’s next appointment and to the social work EHR pool for the patient’s social worker. The note included a score summary table across measures/domains indicating areas requiring follow-up versus no concerns. Separate templated smart phrases for follow-up documentation were developed for the medical and social work teams. Social work documentation also included pre-defined fields to capture services offered, intervention intensity, and time spent on follow-up. Implementation strategies . Implementation was optimized using evidence-informed strategies catalogued through the Expert Recommendations for Implementing Change (ERIC) project: 23 screening champions; patient, caregiver, and clinician education; minimization of screening burden; and language accessibility. Clinical leaders—medical directors and psychosocial managers—acted as champions by participating in program development, providing feedback, and promoting implementation. Clinician education regarding program purpose, response to screening results (Blueprint for Care; Table 2 ), and documentation expectations was offered during standing meetings and scheduled sessions, and through real-time clinical review and documentation. Standard operating procedures were developed for medical, social work, and screening teams. Patient/caregiver education on the screening program was provided through existing newly diagnosed family education and flyers. To minimize screening burden, surveys were sent one week prior to a scheduled clinic visit. Reminders were sent via MyChart and by phone if screening was incomplete within a few days of the appointment. Between June 2023–November 2024, patients/caregivers without MyChart access or who did not complete screening prior to their appointment were offered portal registration and/or in-clinic completion via iPad; this process was discontinued (see Results). Our hospital’s Language Services translated measures and screening program communications/instructions if translated measures did not exist. Implementation Evaluation and Outcomes Evaluation was comprised of: (1) Adoption : Overall rate of screening completion by timepoint, mode of completion, language, and site; (2) Feasibility : EHR documentation that results were delivered to clinicians; (3) Penetration : EHR documentation that patient-caregiver-clinician communication and follow-up occurred as indicated in the in medical and social work progress notes; (4) Sustainability : Acceptability ratings from patients and caregivers collected via screening 24 and data on satisfaction through patient, caregiver, and clinician interviews; (5) Adaptations : Changes made based on review of outcomes, data related to (1)-(4), were continuously tracked (Fig. 2 ). Qualitative Interviews . An interview guide, informed by the Consolidated Framework for Implementation Research (CFIR) 25 and developed in partnership with the working group, evaluated acceptability, screening barriers, impact on care, and implementation strategies among patients and caregivers who completed screening. Approximately one-month post-screening, with interpreter support as needed, patients and caregivers were invited to participate in a structured phone interview using the interview guide and responses were recorded in REDCap. 21 Clinicians of patients and caregivers who completed screening were emailed a REDCap 21 survey with open-ended questions about workflow integration, impact on patient/caregiver communication, and implementation strategies based on the interview guide. The screening team analyzed patient and caregiver responses inductively by question, with frequencies of perspectives across CFIR domains recorded. Clinician responses were coded as barriers to implementation and effective implementation strategies, with code counts recorded. Adaptations. During implementation, patient, caregiver, and clinician and screening team feedback was regularly reviewed to inform adaptations (i.e., modifications to the program and strategies to address identified barriers). Adaptations were recorded in real time in a spreadsheet indicating the modification, date of modification, problem addressed, and its data source. Results Starting in June 2023, the psychosocial screening program rolled out in phases for patient populations, languages, and sites (Fig. 1 ). A doption, Feasibility, and Penetration As of November 2025, 846 surveys were sent to patients (n = 306) and caregivers (n = 540) across timepoints, with 470 (56%) completed overall (Table 3 , Fig. 2 ), representing 380 unique patients. Nineteen caregivers and 4 patients completed screening in Spanish, and 3 caregivers in Arabic. As expected, screening was primarily distributed and completed at the main site and with hematologic malignancies (first implementation phase, largest cancer center population). Table 3 Adoption Initial Diagnosis, n (%) Short-Term Follow-Up, n (%) Long-Term Follow-Up, n (%) Patient Caregiver Patient Caregiver Patient Caregiver Surveys Completed † 51/92 (55%) 129/195 (66%) 67/132 (51%) 144/243 (59%) 30/82 (37%) 49/102 (48%) Patient Age Group 0‒10 years - 81 (63%) - 95 (66%) - 28 (57%) 11‒17 years 40 (78%) 48 (37%) 40 (60%) 49 (34%) 15 (50%) 21 (43%) ≥18 years 11 (22%) - 27 (40%) - 15 (50%) - Mode of Completion Remotely via MyChart 22 (43%) 77 (60%) 47 (70%) 106 (74%) 22 (73%) 39 (80%) In Clinic 29 (57%) 52 (40%) 20 (30%) 38 (26%) 8 (27%) 10 (20%) Language English 49 (96%) 120 (93%) 66 (99%) 133 (92%) 29 (97%) 47 (96%) Spanish 2 (4%) 7 (5%) 1 (1%) 10 (7%) 1 (3%) 2 (4%) Arabic 0 (0%) 2 (2%) 0 (0%) 1 (1%) 0 (0%) 0 (0%) Site Main Hospital 44 (86%) 101 (78%) 49 (73%) 109 (76%) 21 (70%) 35 (71%) KOP Specialty Care 5 (10%) 21 (16%) 14 (21%) 21 (14%) 3 (10%) 10 (20%) VNJ Specialty Care 2 (4%) 7 (5%) 4 (6%) 14 (10%) 6 (20%) 4 (8%) Service Hematologic Malignancy 21 (41%) 65 (50%) 40 (60%) 86 (60%) 17 (57%) 31 (63%) Solid Tumors 27 (53%) 55 (43%) 27 (40%) 54 (37%) 12 (40%) 14 (29%) Brain Tumors 3 (6%) 9 (7%) 0 (0%) 4 (3%) 1 (3%) 4 (8%) Domains Flagged for Follow-Up Patient Cancer-related Symptoms 4/20 (20%) 24/72 (33%) 15/46 (33%) 19/95 (20%) - - Patient Medication Management 3/10 (30%) - 5/25 (20%) - 2/15 (13%) - Patient Physical Quality of Life 40/51 (78%) 84/117 (72%) 32/67 (48%) 76/141 (54%) 10/30 (33%) 34/49 (69%) Patient Social Quality of Life 7/51 (14%) 19/116 (16%) 9/66 (14%) 27/141 (19%) 2/29 (7%) 11/49 (22%) Patient Emotional Functioning 25/51 (49%) 81/129 (63%) 28/67 (42%) 52/144 (36%) 9/29 (31%) 17/49 (35%) Patient Neurocognitive Functioning 0/1 (0%) 37/82 (45%) 14/65 (22%) 59/121 (49%) 6/28 (21%) 23/46 (50%) Caregiver Adjustment - 74/128 (58%) - 53/143 (37%) - 25/49 (51%) Family Factors - 18/128 (14%) - 21/140 (15%) - 7/47 (15%) Resource Needs 4/10 (40%) 62/128 (48%) 14/25 (56%) 60/141 (43%) 8/15 (53%) 9/48 (19%) Note. Percentages may not equal 100 due to rounding. Survey measures were completed only by eligible respondents (per validation criteria: age; patient/caregiver); denominators vary by domain. † Patient Age Group, Mode of Completion, Language, Site, Service, and Domains Flagged for Follow-Up are reported for completed surveys only. At initial diagnosis, 55% of patients and 66% of caregivers completed screening, with 43% and 60% via MyChart and 96% and 93% in English respectively. The most frequently endorsed clinical concerns (flagged for follow-up) for patients were Physical Quality of Life (78%), Emotional Functioning (49%), and Resource Needs (40%), and for caregivers, their child’s Physical Quality of Life (72%) and Emotional Functioning (63%), and Caregiver Adjustment (58%). At short-term follow-up, 51% of patients and 59% of caregivers completed screening, with 70% and 74% via MyChart and 99% and 92% in English respectively. The most frequently endorsed concerns for patients were Physical Quality of Life (48%), Emotional Functioning (42%), and Resource Needs (56%) and for caregivers, their child’s Physical Quality of Life (54%) and Neurocognitive Functioning (49%), and Resource Needs (43%). At long-term follow-up, 37% of patients and 48% of caregivers completed screening, with 73% and 80% via MyChart and 97% and 96% in English respectively. The most frequently endorsed concerns for patients were Physical Quality of Life (33%), Emotional Functioning (31%), and Resource Needs (53%) and for caregivers, their child’s Physical Quality of Life (69%) and Neurocognitive Functioning (50%) and Caregiver Adjustment (51%). Medical clinicians had a documentation rate of 34% (n = 129/376) of which 93% (n = 120) indicated screening results were discussed with the family and 7% (n = 9) indicated results were not discussed. The social work team had a documentation rate of 74% (n = 279/376). Among completed notes, 4% (n = 10) documented attempted contact but were unable to reach the family, 30% (n = 85) indicated no follow-up was needed [of which 78% (n = 66) documented professional collaboration], 4% (n = 10) reported the social work team was already engaged with family, and 62% (n = 174) documented interventions. Interventions included Social Work Assessment and Intervention (89%; n = 155), Financial Assessment and Resource Referral (33%; n = 57), and Care Coordination and Interdisciplinary Intervention (23%; n = 40). (Percentages reflect the proportion of patients receiving each intervention type; and therefore, do not sum to 100%.) The average duration of interventions was 32.7 (SD = 15.6) minutes, with acuity of 1 (8%), 2 (50%), and 3 (42%), with 3 indicating the highest acuity. Acceptability On the acceptability rating scale (1 = strongly disagree to 5 = strongly agree), average caregiver and patient ratings respectively for (1) “Completing the survey prior to or during my clinic visit worked well” (Mean = 3.7/5, 3.8/5) and (2) “The amount of time it took to complete the survey was okay” (Mean = 3.5/5, 3.8/5) indicated moderate acceptability. Ratings for both items and for caregivers and patients, respectively, were lowest at initial diagnosis [Mean(1) = 3.7, 3.8; Mean(2) = 3.5, 3.5], higher at short-term follow-up [Mean(1) = 3.7, 3.8; Mean(2) = 3.6, 3.8], and highest at long-term follow-up [Mean(1) = 3.9, 4.1; Mean(2) = 3.7, 4.1]. For patient/caregiver interviews, responses to each question fell into contrasting perspectives across CFIR domains, with 90% indicating that the survey was easy to complete, 79% that the length was acceptable, 83% that they understood the screening program and its goals, and 52% that the screening helped them communicate their needs to their health care team (Table 4 ). Although most (61%) patients/caregivers viewed the Cancer Center as a resource prior to screening, for 39% screening increased their awareness of ways the Cancer Center supports families and about a quarter believed screening changed their interactions with and resources received from their team. Table 4 Frequencies of Patient and Caregiver Interview Codes Interview Themes and Codes Year 1 Year 2 Year 3 Years 1–3 PT n CGR n TOTAL % PT n CGR n TOTAL % PT n CGR n TOTAL % n % OPSP Survey Experience Survey was Easy to Complete/Comprehensive 4 18 96% 2 10 80% 1 11 92% 46 90% Survey was Difficult to Complete 0 1 4% 0 3 20% 0 1 8% 5 10% OPSP Survey Length Survey Length was Acceptable 4 14 82% 2 9 63% 1 8 82% 38 79% Survey Length was Not Acceptable 0 4 18% 0 4 27% 0 2 18% 10 21% Education and Communication about OPSP Sufficient Communication/Education 4 14 86% 2 11 93% 1 7 67% 39 83% Did Not Have Sufficient Communication/Education 0 3 14% 0 1 7% 0 4 33% 8 17% Modes of Communicating Needs Perceived Advantages to Communicating Needs via Survey 1 8 41% 1 3 29% 1 6 58% 20 42% No Difference Between Survey/Sharing Directly 1 0 5% 0 2 14% 0 3 25% 6 13% Preference for Direct Communication with Care Team 2 10 55% 1 7 57% 0 2 17% 22 46% Impact of OPSP on Identifying/Communicating Needs Helped Identify/Communicate Needs 1 7 38% 2 5 54% 1 8 75% 24 52% Did Not Help Identify/Communicate Needs 3 10 62% 0 6 46% 0 3 25% 22 48% Impact of OPSP on Interactions with Care Team Facilitated or Enhanced Care Team Interactions 0 6 27% 0 2 17% 0 4 33% 12 26% No Change in Interactions with Care Team 4 12 73% 2 8 83% 1 7 67% 34 74% Impact of OPSP on Family Resources Enhanced Access to or Awareness of Resources 0 3 14% 0 5 38% 1 4 45% 13 29% Did not Change Resources for Family 4 14 86% 2 6 62% 0 6 55% 32 71% Impact of OPSP on the Cancer Center as a Resource Strengthened Perception of Cancer Center as a Resource 0 5 26% 2 3 36% 1 7 62% 18 39% Perception Remained Positive and Unchanged 4 10 74% 0 9 64% 0 5 38% 28 61% Cancer Center Responsiveness to Family Needs/Strengths Suggestions to Improve Support for Families 1 6 39% 0 1 10% 1 3 33% 12 30% Current Support Adequately Meets Family Needs 3 8 61% 1 8 90% 0 8 67% 28 70% Abbreviations : OPSP (Onco Psychosocial Screening Program), PT (Patient), CGR (Caregiver) Note. Frequencies reflect coded responses from n = 7 patients (PT) and n = 45 caregivers (CGR) across Year 1 (2023), Year 2 (2024), and Year 3 (2025). Percentages were calculated using question-specific denominators (i.e., the number of participants who responded to each item). Because not all participants answered every question, n varies by item. “Total” represents aggregated frequencies across Years 1–3. Responses from oncologists, nurse practitioners, and social workers reflected more positive feedback on implementation strategies (112 coded responses) than barriers (66 coded responses). Identified barriers were impact on workflow (81%), having access to specific screening responses to guide follow-up (8%), uncertainty of value added (8%), and potential burden of survey completion on patients/caregivers (3%). However, clinicians also highlighted effective implementation strategies from initiation through adaptions: the Cancer Center valuing universal psychosocial screening (35%), timely receipt of screening results (23%), easy-to-access/understandable results (19%), preparation/education on how to review and follow-up on screening results with patients/caregivers (17%), and screening created additional ways to communicate with patients/caregivers about needs and concerns (6%). Adaptations and Sustainability Among 55 adaptations, 45 (82%) were made to five components of the screening program: education, administrative workflow, screening assessment and user interface, clinical workflow, and sustainability. Education adaptations (9%, n = 5) included changes to education/training (e.g., 1:1 education for new clinicians or those unable to attend scheduled sessions). Screening administrative workflow (18%, n = 8) adaptations focused on operational processes (e.g., adjusted timing for sending surveys to patients/caregivers prior to scheduled appointments). Screening assessment/user interface (36%, n = 16) adaptations consisted of changes to the screening surveys, interface with families, or timing (e.g., added SSPedi 26 for relevance to clinical care; removed redundant measures of physical quality of life and neurocognition to reduce burden; added open-ended ‘agenda setting’ questions on current concerns). Clinical workflow (18%, n = 8) adaptations involved changes to clinical processes (e.g., added interventions to social work note template to ease documentation burden; updated score summary reports to provide specific information on screening survey responses). Sustainability (18%, n = 8) adaptations were made to promote long-term program continuity (e.g., developed a more efficient EHR-based patient eligibility report; built automated alerts to screening team regarding screening initiation/completion; and discontinued in-clinic completion due to limited feasibility across sites and missed same-day results within clinical workflows). Changes were also made to tracking logs, databases, and interviews to improve quality improvement project workflow (18%, n = 10). Discussion Consistent with the Psychosocial Standards of Care in Childhood Cancer, using rigorous quality improvement processes, we achieved development, implementation, and modification of a psychosocial screening program across our large cancer center. Patients, caregivers, and clinicians generally reported that screening was acceptable, providing an additional, important opportunity to share needs and access resources. Screening prompted discussions with patients/families and increased multidisciplinary collaboration, both for follow-up required and no follow-up required. However, patients and caregivers highlighted the need for a shorter screening, and challenges occurred in fully integrating screening processes into the EHR. Our quality improvement process of phased implementation and applying REAM 19 , 20 allowed for ongoing review and modification of the program over time to address barriers as they were identified, potentially improving our implementation outcomes. To meet the Standards, children’s cancer programs that aim to establish screening programs face barriers to universal screening depending on program characteristics (e.g., size, hospital and community resources), culture around patient/family assessments, and flexibility of the EHR. Continual review of feedback and real-time adaptations guided by REAM 19 , 20 were critical to achieving our aims. Although large in terms of patient population size, complexity, and geography, characteristics of our Cancer Center (e.g., integrated, multidisciplinary psychosocial services) presented opportunities to identify and address multilevel implementation barriers, sufficient staffing to respond to identified needs, and experience with multidisciplinary partnerships around innovative programming. In addition, our screening team included Cancer Center leaders who championed the screening program and fostered buy-in to improve access to care. These factors enabled significant progress toward universal screening and helped establish processes that can serve as a model for other children’s cancer programs. Attention to barriers at the patient/caregiver and program/institution levels generated screening implementation strategies generalizable to other children’s cancer programs. 12 , 14 , 27 , 28 The multilevel implementation strategies based on ERIC 23 (language accessibility, education on value of screening for all involved, ensuring communication with patients/caregivers and among the multidisciplinary team about screening results, attention to burden and workflow, screening champions) are consistent with those noted in other studies of psychosocial screening in childhood cancer, 12,14,28 as well as in a recent systematic review on implementing patient-reported outcomes in adult oncology. 27 Not all barriers were fully addressed, and some barriers (e.g., impact of workflow barriers on patient-caregiver-clinician communication and documentation) represent significant challenges to achieving universal screening. Across implementation phases, and with expansion to most patients, the screening team experienced increasing workload for which we tracked time and effort and made adaptations to automate more processes. Psychosocial screening integrated into the EHR remains a goal as does the need to optimize workflow efficiencies to reduce clinical and screening staff demands and support sustainability. Related to EHR integration, the social work team achieved high rates of documented follow-up and multidisciplinary collaboration. In contrast, limited medical clinician documentation indicates that more can be done to leverage the EHR to facilitate screening workflow. At our center, we continue to pursue full EHR integration of psychosocial screening facilitated by improved visit scheduling, diagnosis documentation, and treatment end-date tracking in the EHR. While using REDCap 21 allows us to administer screening surveys across timepoints, disease groups, sites, timepoints, and languages as well as analyze, refine, and optimize the program in real time, retaining all other program components in the EHR (screening invites, results communication, etc.) will allow for the eventual, seamless transition to fully EHR-based screening. For this screening program, we were able to partner with the CHOP’s Language Services for accurate, reliable translation of measures, instructions, and communications in Spanish and Arabic, and the interpreter team facilitated conversations with families to follow up on screening. Screening in the languages most commonly used in children’s cancer programs in the United States is important given the number of patients/families who speak languages other than English and emerging data regarding health inequities in childhood cancer outcomes. 29 – 31 Caregivers who speak languages other than English may have difficulties fully understanding medical consent, expressing concerns related to their sociocultural contexts, and accessing the resources available to them. 32 There are significant disparities in cancer care and outcomes for Hispanic children who are less likely to participate in research 33 or receive follow-up care, 34 and they are at risk for parental psychological difficulties. 35 Spanish-speaking caregivers in the United States believe their child would have received better cancer care if they spoke English, and language barriers can impact how families engage in care. 33 This report of lessons learned in establishing a psychosocial screening program can facilitate implementation of the Psychosocial Standards of Care. We acknowledge that we had resources to rigorously launch, continuously evaluate, and make modifications to implementation strategies. Nevertheless, identified facilitators and strategies that support sustainability, such as reducing measure redundancies and automating screening processes, are applicable across children’s cancer programs. Ultimately, findings have the potential to inform sustainable implementation of comprehensive, evidence-based, screening in multiple languages at key transitions in cancer treatment towards the goal of improved access to and engagement in care. Declarations Funded by Program implementation was funded by Pfizer Medical Program Grants/PROTEUS Learning Health Network. Competing Interests : The authors have no relevant financial or non-financial interests to disclose. Ethics approval : This research study was conducted retrospectively from data obtained for clinical purposes and in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments. The Children’s Hospital of Philadelphia Institutional Review Board approval was granted to allow for dissemination (CHOP IRB 24-022574). Consent to participate : Not applicable due to retrospective study. Consent to publish : Not applicable due to retrospective study. Author Contribution All authors contributed to study conception and design. Material preparation, data collection, and analysis were performed by Susanna Vargo, Shannon Hammer, and Lamia Barakat. The first draft of the manuscript was written by Lamia Barakat, Shannon Hammer, Susanna Vargo, and Megan Perez. All authors read and approved the final manuscript. Acknowledgement We thank members of the working group, Chelsea Apple, LSW, Iris Paltin, PhD, ABPP-CN, Massiel Ortega Rivera, Tayseer Said, survivor and caregiver advisors, clinical research coordinators (Ashley Anil, Laylah Jones, Nithyasri Ramaswamy), and screening program staff (Cailin Shallow, Kishori Shah). Portions of this paper were presented at the Society of Pediatric Psychology Annual Conference, Phoenix, AZ, 2025 and the 4th Eastern and Northern European Childhood Cancer Conference, Bratislava, Slovakia, 2025. The PROM-GRIP reporting requirements document was used in preparing this study as part of a pilot trial of its utility. Data Availability The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. References Adler, N. E., Page, A. E. K., & Institute of Medicine (US) Committee on Psychosocial Services to Cancer Patients/Families in a Community Setting (Eds.). (2008). Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs . National Academies Press (US). https://doi.org/10.17226/11993 Sharara M, Tjioe KC, Miranda-Galvis M, Santellano Juarez B, Agrawal G, Balas EA, Johnson TS, Cortes JE (2024) Social determinants of health impact on cancer affecting children, adolescents, and young adults: systematic review and meta-analysis. Front Adolesc Med 2:1441776. https://doi.org/10.3389/fradm.2024.1441776 Wiener L, Kazak AE, Noll RB, Patenaude AF, Kupst MJ (2015) Standards for the psychosocial care of children with cancer and their families: an introduction to the special issue. Pediatr Blood Cancer 62(Suppl 5):S419–S424. https://doi.org/10.1002/pbc.25675 Kazak AE, Scialla M, Deatrick JA, Barakat LP (2024) Pediatric psychosocial preventative health model: achieving equitable psychosocial care for children and families. Fam Syst Health 42:76–89. https://doi.org/10.1037/fsh0000856 Kazak AE, Scialla MA, Canter KS, Sardi-Brown V, Buff K, Arasteh K, Pariseau E, Sandler E, Wiener L (2025) Delivering care consistent with the psychosocial standards—Provider report: Implementing the Standards Together–Engaging Parents and Providers in Psychosocial Care (iSTEPPP) study. Pediatr Blood Cancer 72:e31959. https://doi.org/10.1002/pbc.31959 Kazak AE, Abrams AN, Banks J, Christofferson J, DiDonato S, Grootenhuis MA, Kabour M, Madan-Swain A, Patel SK, Zadeh S, Kupst MJ (2015) Psychosocial assessment as a standard of care in pediatric cancer. Pediatr Blood Cancer 62(Suppl 5):S426–S459. https://doi.org/10.1002/pbc.25730 Annett RD, Patel SK, Phipps S (2015) Monitoring and assessment of neuropsychological outcomes as a standard of care in pediatric oncology. Pediatr Blood Cancer 62(Suppl 5):S460–S513. https://doi-org.proxy.library.upenn.edu/ 10.1002/pbc.25749 Pelletier W, Bona K (2015) Assessment of financial burden as a standard of care in pediatric oncology. Pediatr Blood Cancer 62(Suppl 5):S619–S631. https://doi-org.proxy.library.upenn.edu/ 10.1002/pbc.25714 Kearney JA, Salley CG, Muriel AC (2015) Standards of psychosocial care for parents of children with cancer. Pediatr Blood Cancer 62(Suppl 5):S632–S683. https://doi-org.proxy.library.upenn.edu/ 10.1002/pbc.25761 Kazak AE, Schneider S, DiDonato S, Pai AL (2015) Family psychosocial risk screening guided by the Pediatric Psychosocial Preventative Health Model (PPPHM) using the Psychosocial Assessment Tool (PAT). Acta Oncol 54:574–580. https://doi.org/10.3109/0284186X.2014.995774 Pierce L, Hocking MC, Schwartz LA, Alderfer MA, Kazak AE, Barakat LP (2017) Caregiver distress and patient health-related quality of life: psychosocial screening during pediatric cancer treatment. Psychooncology 26:1555–1561. https://doi.org/10.1002/pon.4171 Deatrick JA, Kazak AE, Scialla MA, Madden RE, McDonnell GA, Okonak K, Barakat LP (2022) Advancing health equity in pediatric cancer through implementation of universal family psychosocial risk screening. Psychooncology 31:1483–1490. https://doi.org/10.1002/pon.5978 FitzGerald C, Hurst S (2017) Implicit bias in healthcare professionals: a systematic review. BMC Med Ethics 18:19. https://doi.org/10.1186/s12910-017-0179-8 Kazak AE, Barakat LP, Askins MA, McCafferty M, Lattomus A, Ruppe N, Deatrick J (2017) Provider perspectives on the implementation of psychosocial risk screening in pediatric cancer. J Pediatr Psychol 42:700–710. https://doi.org/10.1093/jpepsy/jsw110 Kazak AE, Brier M, Alderfer MA, Reilly A, Fooks Parker S, Rogerwick S, Ditaranto S, Barakat LP (2012) Screening for psychosocial risk in pediatric cancer. Pediatr Blood Cancer 59:822–827. https://doi.org/10.1002/pbc.24166 Kazak AE, Hwang WT, Chen FF, Askins MA, Carlson O, Argueta-Ortiz F, Barakat LP (2018) Screening for family psychosocial risk in pediatric cancer: validation of the Psychosocial Assessment Tool (PAT) version 3. J Pediatr Psychol 43:737–748. https://doi.org/10.1093/jpepsy/jsy012 Barakat LP, Scialla MA, Ramaswamy N, et al. A comparative effectiveness trial for universal psychosocial screening with the Psychosocial Assessment Tool (PAT) across 18 childhood cancer programs in the United States: adoption, penetration, and health equity. Implement Sci 2026. https://doi.org/10.1186/s13012-026-01493-4 Perez MN, Madden R, Zukin H, Velázquez-Martin BM, Barakat LP (2023) Psychosocial needs of pediatric cancer patients and their caregivers at end of treatment: why psychosocial screening remains important. Pediatr Blood Cancer 70:e30540. https://doi.org/10.1002/pbc.30540 McNall M, Foster-Fishman PG (2007) Methods of rapid evaluation, assessment, and appraisal. Am J Eval 28:151–168. https://doi.org/10.1177/1098214007300895 Smith J, Rapport F, O’Brien TA et al (2020) The rise of rapid implementation: a worked example of solving an existing problem with a new method by combining concept analysis with a systematic integrative review. BMC Health Serv Res 20:449. https://doi.org/10.1186/s12913-020-05289-0 Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L et al (2019) The REDCap consortium: building an international community of software platform partners. J Biomed Inform 95:103208. https://doi.org/10.1016/j.jbi.2019.103208 Wiener L, Kupst MJ, Pelletier W, Kazak AE, Thompson AL (2020) Tools to guide the identification and implementation of care consistent with the psychosocial standards of care. Pediatr Blood Cancer 67:e28586. https://doi.org/10.1002/pbc.28586 Powell BJ, Waltz TJ, Chinman MJ et al (2015) A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project. Implement Sci 10:21. https://doi.org/10.1186/s13012-015-0209-1 Larsen DL, Attkisson CC, Hargreaves WA, Nguyen TD (1979) Assessment of client/patient satisfaction: development of a general scale. Eval Program Plann 2:197–207. https://doi.org/10.1016/0149-7189(79)90094-6 Damschroder LJ, Reardon CM, Widerquist MAO, Lowery J (2022) The updated Consolidated Framework for Implementation Research based on user feedback. Implement Sci 17:75. https://doi.org/10.1186/s13012-022-01245-0 Dupuis LL, Johnston DL, Baggott C, Hyslop S, Tomlinson D, Gibson P, Orsey A, Dix D, Price V, Vanan M, Portwine C, Kuczynski S, Spiegler B, Tomlinson GA, Sung L (2018) Validation of the Symptom Screening in Pediatrics Tool in children receiving cancer treatments. J Natl Cancer Inst 110:661–668. https://doi.org/10.1093/jnci/djx250 Lyu J, Zhang H, Wang H, Liu X, Jing Y, Yin L, Wang A (2024) Facilitators and barriers to implementing patient-reported outcomes in clinical oncology practice: a systematic review based on the Consolidated Framework for Implementation Research. Implement Sci Commun 5:120. https://doi.org/10.1186/s43058-024-00654-0 Paeps M, Scialla MA, Barakat LP, Arasteh K, Kazak AE (2025) Implementing a psychosocial screener in pediatric oncology: perspectives of multidisciplinary clinicians. Psychooncology 34:e70356. https://doi.org/10.1002/pon.70356 Bhatia S (2011) Disparities in cancer outcomes: lessons learned from children with cancer. Pediatr Blood Cancer 56:994–1002. https://doi.org/10.1002/pbc.23078 Gupta S, Wilejto M, Poe J, Guttman A, Sung L (2014) Low socioeconomic status is associated with worse survival in children with cancer: a systematic review. PLoS One 9:e89482. https://doi.org/10.1371/journal.pone.0089482 Wallner LP, Griggs JJ (2018) Advancing the science of cancer health disparities research. J Clin Oncol 36:1–3. https://doi.org/10.1200/JCO.2017.76.0496 Simon C, Zyzanski SJ, Eder M, Raiz P, Kodish ED, Siminoff LA (2003) Groups potentially at risk for making poorly informed decisions about entry into clinical trials for childhood cancer. J Clin Oncol 21:2173–2178. https://doi.org/10.1200/JCO.2003.03.003 Zamora ER, Kaul S, Kirchhoff AC, Gwilliam V, Jimenez OA, Morreall DK, Montenegro RE, Kinney AY, Fluchel MN (2016) The impact of language barriers and immigration status on the care experience for Spanish-speaking caregivers of patients with pediatric cancer. Pediatr Blood Cancer 63:2173–2180. https://doi.org/10.1002/pbc.26150 Milam JE, Meeske K, Slaughter RI, Sherman-Bien S, Ritt-Olson A, Kuperberg A, Freyer DR, Hamilton AS (2015) Cancer-related follow-up care among Hispanic and non-Hispanic childhood cancer survivors: the Project Forward study. Cancer 121:605–613. https://doi.org/10.1002/cncr.29105 Meeske KA, Sherman-Bien S, Hamilton AS, Olson AR, Slaughter R, Kuperberg A, Milam J (2013) Mental health disparities between Hispanic and non-Hispanic parents of childhood cancer survivors. Pediatr Blood Cancer 60:1470–1477. https://doi.org/10.1002/pbc.24527 Gruber-Baldini AL, Velozo C, Romero S, Shulman LM (2017) Validation of the PROMIS® measures of self-efficacy for managing chronic conditions. Qual Life Res 26:1915–1924. https://doi.org/10.1007/s11136-017-1527-3 Varni JW, Seid M, Kurtin PS (2001) PedsQL 4.0: reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations. Med Care 39:800–812. https://doi.org/10.1097/00005650-200108000-00006 HealthMeasures (2018) HealthMeasures disease-specific guide: pediatric cancer. https://www.healthmeasures.net/images/applications/Health-Measures-Disease- Specific-Guide-Pediatric%20Cancer-2018_10_29.pdf HealthMeasures (2022) HealthMeasures disease-specific guide: cancer. https://www.healthmeasures.net/images/PROMIS/Selecting_Among_Measurement_Systems/Health_Measures_Disease_Specific_Guide_-_Cancer_2022_05_24.pdf Tucker CA, Bevans KB, Becker BD, Teneralli R, Forrest CB (2020) Development of the PROMIS Pediatric Physical Activity Item Banks. Phys Ther 100:1393–1410. https://doi.org/10.1093/ptj/pzaa074 Haverman L, et al. (2013) Development and validation of the distress thermometer for parents of a chronically ill child. J Pediatr 163:1140–1146.e2. https://doi.org/10.1016/j.jpeds.2013.06.011 Northman L, Morris M, Loucas C, et al (2018) The effectiveness of a hospital-based school liaison program: a comparative study of parental perception of school supports for children with pediatric cancer and neurofibromatosis type 1. J Pediatr Oncol Nurs 35:276–286. https://doi.org/10.1177/1043454218765140 Willcutt EG, et al. (2011) Colorado Learning Difficulties Questionnaire: validation of a parent-report screening measure. Psychol Assess 23:778–791. https://doi.org/10.1037/a0023290 Cox, E. D., Fritz, K. A., Hansen, K. W., Brown, R. L., Rajamanickam, V., Wiles, K. E., Fate, B. H., Young, H. N., & Moreno, M. A. (2014). Development and validation of PRISM: a survey tool to identify diabetes self-management barriers. Diabetes research and clinical practice , 104 (1), 126–135. https://doi.org/10.1016/j.diabres.2014.01.015 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 05 May, 2026 Editor assigned by journal 05 May, 2026 Submission checks completed at journal 02 Apr, 2026 First submitted to journal 23 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9202191","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":634945820,"identity":"6cbadb93-5d30-4db5-8ef4-5a1955bd3129","order_by":0,"name":"Lamia P. Barakat","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvklEQVRIiWNgGAWjYBACAyBmbGBgkGOQAPOZidZiYEy6lsQGorWYs599+HFGzZ/0/tnNxx4wVFgnNhDSYtmTbiy54ZhB7ow7x9INGM6kE9ZicCCNQfIBm0HuBokcMwnGtsNEaDn/jPnng38G6QZgLf+I0XIjjU1yY5tBAkRLAxFaLGc8Y7Oc2WdsOONGWrpBwrF0Y4JazPnTmG/2fJOT55+RfOzBhxprWYJakAEbQwIpyiFaRsEoGAWjYBRgAwBT1T2MASq3tAAAAABJRU5ErkJggg==","orcid":"","institution":"Children's Hospital of Philadelphia","correspondingAuthor":true,"prefix":"","firstName":"Lamia","middleName":"P.","lastName":"Barakat","suffix":""},{"id":634945821,"identity":"d77113d6-e360-4f5f-a393-b2ee74d93be6","order_by":1,"name":"Susanna Vargo","email":"","orcid":"","institution":"Children's Hospital of Philadelphia","correspondingAuthor":false,"prefix":"","firstName":"Susanna","middleName":"","lastName":"Vargo","suffix":""},{"id":634945822,"identity":"e38d5448-d060-4dee-ada9-2b020cdc13ba","order_by":2,"name":"Shannon N. Hammer","email":"","orcid":"","institution":"Children's Hospital of Philadelphia","correspondingAuthor":false,"prefix":"","firstName":"Shannon","middleName":"N.","lastName":"Hammer","suffix":""},{"id":634945823,"identity":"b498b01e-a0a1-49d4-aedb-0f244b02b8aa","order_by":3,"name":"Anne Reilly","email":"","orcid":"","institution":"Children's Hospital of Philadelphia","correspondingAuthor":false,"prefix":"","firstName":"Anne","middleName":"","lastName":"Reilly","suffix":""},{"id":634945824,"identity":"858c5482-5c7e-4112-b68d-b80619ff60d4","order_by":4,"name":"Charles Phillips","email":"","orcid":"","institution":"Children's Hospital of Philadelphia","correspondingAuthor":false,"prefix":"","firstName":"Charles","middleName":"","lastName":"Phillips","suffix":""},{"id":634945825,"identity":"51432f27-514c-4518-b8fe-3659f7e7492f","order_by":5,"name":"Patricia Burns-Lynch","email":"","orcid":"","institution":"Children's Hospital of Philadelphia","correspondingAuthor":false,"prefix":"","firstName":"Patricia","middleName":"","lastName":"Burns-Lynch","suffix":""},{"id":634945826,"identity":"41b4998e-7203-429d-b8d2-828c0f17f960","order_by":6,"name":"Lisa A. Schwartz","email":"","orcid":"","institution":"Children's Hospital of Philadelphia","correspondingAuthor":false,"prefix":"","firstName":"Lisa","middleName":"A.","lastName":"Schwartz","suffix":""},{"id":634945827,"identity":"d8a554f2-3d57-40e7-bd2e-5dca783380ce","order_by":7,"name":"Megan N. Perez","email":"","orcid":"","institution":"Children's Hospital of Philadelphia","correspondingAuthor":false,"prefix":"","firstName":"Megan","middleName":"N.","lastName":"Perez","suffix":""}],"badges":[],"createdAt":"2026-03-23 15:08:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9202191/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9202191/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":109214971,"identity":"8deec7a5-2cf6-44c5-b8a4-0b7799cae574","added_by":"auto","created_at":"2026-05-13 17:50:07","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":114341,"visible":true,"origin":"","legend":"\u003cp\u003eImplementation Timeline\u003c/p\u003e","description":"","filename":"groupimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9202191/v1/68d94c881cd7a5068522ce30.jpeg"},{"id":109214972,"identity":"733caf7d-9846-48a0-8f27-11713e12b158","added_by":"auto","created_at":"2026-05-13 17:50:07","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":65110,"visible":true,"origin":"","legend":"\u003cp\u003eCONSORT\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ec\u003c/sup\u003e Developmental Delay (n=1 Patient), Language Not Available (n=1 Caregiver), No MyChart Access (n=1 Patient, n=1 Caregiver)\u003c/p\u003e\n\u003cp\u003eNote. \u003cu\u003ePatients\u003c/u\u003e (≥11 years old); \u003cu\u003eCaregivers\u003c/u\u003e (of Patients 0-17 years old)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eIneligible Language:\u003c/u\u003e Any language other than English, Spanish, or Arabic.\u003cu\u003e\u0026nbsp;\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eReasons Surveys Not Sent\u003c/u\u003e:\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea \u003c/sup\u003eDevelopmental Delay (n=1 Patient), Language Not Available (n=3 Patients, n=4 Caregivers), No MyChart Access(n=1 Patient, n=1 Caregiver), Missed by OPSP Team (n=1 Patient)\u003c/p\u003e\n\u003cp\u003e\u003csup\u003eb \u003c/sup\u003eDevelopmental Delay (n=1 Patient, n=1 Caregiver), Language Not Available (n=3 Patients, n=6 Caregivers), No MyChart Access (n=1 Caregiver), Missed by OPSP Team (n=1 Caregiver)\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9202191/v1/0553571d22151a0037f15224.png"},{"id":109252184,"identity":"1a7218ce-f32b-428d-a47a-76f8dd1ea64e","added_by":"auto","created_at":"2026-05-14 09:22:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":838400,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9202191/v1/6fd79541-68c9-4613-9807-6a5a007e470c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Implementation of a Universal Psychosocial Screening Program Across the Pediatric Cancer Treatment Trajectory: A Standard of Care","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe diagnosis and treatment of pediatric cancer adversely affect multiple levels of a family\u0026rsquo;s social ecology, including patient and caregiver physical and psychosocial health.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Families with limited instrumental and social resources and pre-existing child and family problems are particularly at risk for health disparities and challenges traversing childhood cancer care.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e As such, there is recognition of the importance of evidence-based psychosocial care for children with cancer and their families for facilitating adjustment through consistent access to and engagement in care matched to needs.\u003csup\u003e\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e The 2015 Institute of Medicine Report and the Standards of Psychosocial Care in Childhood Cancer call for improvement in delivery of psychosocial care.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Unfortunately, few children\u0026rsquo;s cancer programs offer care consistent with the Standards in a universal, systematic manner, highlighting critical gaps that can limit medical and psychosocial outcomes and magnify health disparities.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThis project addresses the call to translate the Standards into clinical care by focusing on implementing the First Standard, \u003cem\u003eYouth with cancer and their family members should routinely receive systematic assessments of their psychosocial health care needs\u003c/em\u003e,\u003csup\u003e6\u003c/sup\u003e and expanding to related Standards of \u003cem\u003eneuropsychological assessment\u003c/em\u003e (Standard 2),\u003csup\u003e7\u003c/sup\u003e \u003cem\u003eassessment of financial needs\u003c/em\u003e (Standard 5),\u003csup\u003e8\u003c/sup\u003e and \u003cem\u003epsychosocial care for parents\u003c/em\u003e (Standard 6).\u003csup\u003e9\u003c/sup\u003e The First Standard emphasizes the role of psychosocial screening with patient- and caregiver-reported outcome measures at diagnosis and treatment transitions.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e Universal screening facilitates early identification of psychosocial risks, initiates preventive interventions to support long-term health-related quality of life, promotes access to targeted, evidence-based care matched to need, reduces implicit bias inherent in non-systematic assessment, and supports equitable, cost-effective integrated psychosocial services.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e Further, psychosocial screening at key treatment transitions (e.g., end of active treatment) allows clinicians to assess emerging or persistent patient and caregiver challenges and to adjust care to promote post-treatment adjustment and continued engagement in care.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe Standards have set expectations for psychosocial care across children\u0026rsquo;s cancer programs, but implementation has been inconsistent due to barriers at the patient/caregiver, clinician, programmatic, and institutional levels.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e Facilitators of care consistent with the Standards have been identified, and there is value in understanding how to leverage implementation strategies in clinical care to support adoption of screening. Evidence suggests screening is acceptable to patients and caregivers, and feasible to implement in clinical care. However, clinicians are concerned with potential challenges in clinic workflow, time and effort required to screen and respond to screening, and costs of meeting identified needs.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e At the institutional level, it is important to identify screening champions and ensure funding for psychosocial programs that include screening. For example, a recent study suggests few programs view themselves as sufficiently staffed to provide services consistent with the Standards, and financial considerations are noted as a barrier to staffing.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Also, there was limited growth in psychosocial programs over a 10-year period.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Taken together, attention to barriers and facilitators is critical to successful implementation of care consistent with the Standards.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eBuilding from prior studies in our children\u0026rsquo;s cancer program,\u003csup\u003e11,12,14,16\u0026ndash;18\u003c/sup\u003e we designed a universal psychosocial screening program with patient- and caregiver-reported outcome measures at three timepoints in the cancer treatment trajectory. The program was implemented, evaluated, and modified in phases across three Children\u0026rsquo;s Hospital of Philadelphia (CHOP) Cancer Center disease groups, sites, and screening languages. Implementation strategies were integrated into clinical care, evaluated after each phase, and modified based on ongoing evaluation. Implementation outcomes are described: (1) \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eadoption\u003c/span\u003e (patient and caregiver completion of surveys), (2) \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003efeasibility\u003c/span\u003e (communication of results to clinicians), (3) \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003epenetration\u003c/span\u003e (clinician documentation of discussion of screening results with patients/caregivers), and (4) modifications for \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003esustainability\u003c/span\u003e were informed by patient and caregiver acceptability ratings and qualitative feedback from patients, caregivers, and clinicians. We also present \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eadaptations\u003c/span\u003e, or iterative modifications to address identified barriers and promote sustainability of the screening program.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis quality improvement project was conducted at the CHOP Cancer Center. We utilized a multi-phased approach to implement psychosocial screening (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) across its disease groups (Hematologic Malignancies, Solid Tumors, Brain Tumors), sites (Main Hospital in Philadelphia, PA and Specialty Care Centers in King of Prussia, PA and Voorhees, NJ), and most commonly used languages in our center (English, Spanish, Arabic). Institutional Review Board approval allowed for dissemination (CHOP IRB 24-022574). Clinical trial number: not applicable.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eRapid Evaluation and Assessment Methods (REAM),\u003csup\u003e19,20\u003c/sup\u003e guidelines for gathering reliable information on the current services for efficient integration into health care systems and improved responsiveness, patient/caregiver/clinician satisfaction, and service delivery, informed pre-implementation planning and implementation and evaluation. Using REAM,\u003csup\u003e19,20\u003c/sup\u003e iterative modifications and/or enhancements (\u0026ldquo;adaptations\u0026rdquo;) to the screening program and its implementation were made based on continuous review of outcomes at each implementation phase, and discussion among the screening team, working group members, and relevant clinicians.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePre-implementation Planning\u003c/h2\u003e \u003cp\u003e\u003cb\u003eInterdisciplinary Workgroup\u003c/b\u003e. In late 2021, the screening team formed an interdisciplinary workgroup of CHOP Cancer Center staff (n\u0026thinsp;=\u0026thinsp;10; pediatric psychology, neuropsychology, social work, child life, hospital school program, nursing) and pediatric patient/caregiver community members (n\u0026thinsp;=\u0026thinsp;2) to begin planning a screening program within routine clinical care. The working group appraised the literature review on screening, prepared an institutional assessment of current practice, identified implementation strategies, and provided input throughout planning and preparation.\u003c/p\u003e \u003cp\u003e \u003cb\u003eInstitutional Assessment\u003c/b\u003e. Existing screening processes were assessed via REDCap\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e survey of 13 clinicians involved in psychosocial assessments in our cancer program, in accordance with published recommendations for implementing the Psychosocial Standards of Care.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e Results indicated psychosocial screening was semi-structured and primarily occurred immediately following diagnosis or as needed. Evidence-based, psychometrically-sound, patient-reported outcome measures were not integrated into screening. Although screening was documented in the electronic health record (EHR), documentation was not templated. We also identified the need for a blueprint to guide the team in systematically matching resources to needs and coordinating multidisciplinary follow-up.\u003c/p\u003e \u003cp\u003e \u003cb\u003eKey elements of screening program\u003c/b\u003e. Next, core components were determined: timing, patient- and caregiver-reported outcome priorities/domains to impact care (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), and guidance on addressing needs identified through screening (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). A plan for communication with patients, caregivers, and clinicians via the EHR was developed for clinical integration of screening data and documentation of follow-up along with related workflows. Full EHR integration did not allow for comprehensive screening and potential changes in measures, screening processes, and expansion; therefore, we proceeded with screening via REDCap\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e and communication and documentation via the EHR.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOncology Psychosocial Screening Program Elements\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhy?\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTo enhance clinical care, address health inequities in pediatric cancer, identify areas of risk and resilience, and facilitate timely and targeted assessment/intervention.\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWho?\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ePopulation\u003c/span\u003e: Patients (\u0026ge;\u0026thinsp;11 years) and Caregivers (of patients 0\u0026ndash;17 years) in the CHOP Cancer Center\u003c/p\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eService\u003c/span\u003e: Hematologic Malignancies, Solid Tumors, Brain Tumors\u003c/p\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eLanguage\u003c/span\u003e: English, Spanish, Arabic\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhat?\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eScreening Domains\u003c/span\u003e\u003c/p\u003e \u003cp\u003eCancer-Related Symptoms\u003c/p\u003e \u003cp\u003eMedication Management\u003c/p\u003e \u003cp\u003ePhysical Quality of Life\u003c/p\u003e \u003cp\u003eSocial Quality of Life\u003c/p\u003e \u003cp\u003eEmotional Functioning\u003c/p\u003e \u003cp\u003eNeurocognitive Functioning\u003c/p\u003e \u003cp\u003eCaregiver Adjustment\u003c/p\u003e \u003cp\u003eFamily Factors\u003c/p\u003e \u003cp\u003eResource Needs\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhere?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eScreening Sites\u003c/span\u003e\u003c/p\u003e \u003cp\u003ePhiladelphia, PA Main Hospital\u003c/p\u003e \u003cp\u003eKing of Prussia, PA Specialty Care\u003c/p\u003e \u003cp\u003eVoorhees, NJ Specialty Care\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhen?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eScreening Timepoints\u003c/span\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eInitial Diagnosis\u003c/em\u003e (4\u0026ndash;6 months post-diagnosis)\u003c/p\u003e \u003cp\u003e\u003cem\u003eShort-Term Follow-Up\u003c/em\u003e (18\u0026ndash;24 months post-diagnosis)\u003c/p\u003e \u003cp\u003e\u003cem\u003eLong-Term Follow-Up\u003c/em\u003e (4\u0026ndash;6 years post diagnosis/survivorship)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHow?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eScreening Process\u003c/span\u003e\u003c/p\u003e \u003cp\u003e\u0026#151; Screening surveys were delivered to patients and caregivers via a MyChart message with a REDCap\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e link and completed remotely or in clinic.\u003c/p\u003e \u003cp\u003e\u0026#151; Screening results were shared in an EHR Care Coordination note routed to oncology clinicians and social workers prior to the patient\u0026rsquo;s clinic appointment.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eAbbreviations\u003c/span\u003e: CHOP (Children\u0026rsquo;s Hospital of Philadelphia), EHR (Electronic Health Record)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMeasures with Clinical Cutoffs indicating Needs Follow-Up\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eDomain\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eMeasure\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eRisk Score\u003c/span\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e(Flagged for Follow-Up)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003eReporter (PT age)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eTimepoint\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003ePT\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u003cb\u003eCGR\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eSelf\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eProxy\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eSelf\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCancer-Related Symptoms\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(+) SSPedi \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e[\u0026ge;\u0026thinsp;1 Symptom\u0026thinsp;=\u0026thinsp;4 or 5] \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eID, SF\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMedication Management\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePROMIS: Self-Efficacy\u0026ndash;Managing Med \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eT-Score\u0026thinsp;\u0026lt;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eID, SF, LF\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003e\u003cb\u003ePhysical Quality of Life\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePedsQL: Physical Functioning \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eScale Score\u0026thinsp;\u0026lt;\u0026thinsp;65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u0026ndash;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eID, SF, LF\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePROMIS: Physical Function Mobility \u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eT-Score\u0026thinsp;\u0026lt;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eID, SF, LF\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePROMIS: Physical Function \u003csup\u003ee\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eT-Score\u0026thinsp;\u0026lt;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eID, SF, LF\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePROMIS: Fatigue \u003csup\u003ed,e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eT-Score\u0026thinsp;\u0026gt;\u0026thinsp;55,\u003csup\u003ec\u003c/sup\u003e 60\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eID, SF, LF\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePROMIS: Pain Interference \u003csup\u003ed,e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eT-Score\u0026thinsp;\u0026gt;\u0026thinsp;55,\u003csup\u003ec\u003c/sup\u003e 60\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eID, SF, LF\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(+) PROMIS: Sleep Disturbance \u003csup\u003ee,f\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eT-Score\u0026thinsp;\u0026gt;\u0026thinsp;60,\u003csup\u003ee,f\u003c/sup\u003e 59\u003csup\u003eg\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eID, SF, LF\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(-) PROMIS: Physical Activity \u003csup\u003eg\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eT-Score\u0026thinsp;\u0026lt;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eID, SF, LF\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eSocial Quality of Life\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePedsQL: Social Functioning \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eScale Score\u0026thinsp;\u0026lt;\u0026thinsp;65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u0026ndash;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eID, SF, LF\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePROMIS: Peer Relationships \u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eT-Score\u0026thinsp;\u0026lt;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eID, SF, LF\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePROMIS: Social Roles/Activities \u003csup\u003ee\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eT-Score\u0026thinsp;\u0026lt;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eID, SF, LF\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cb\u003eEmotional Functioning\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePedsQL: Emotional Functioning \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eScale Score\u0026thinsp;\u0026lt;\u0026thinsp;65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u0026ndash;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eID, SF, LF\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePROMIS: Anxiety \u003csup\u003ed,e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eT-Score\u0026thinsp;\u0026gt;\u0026thinsp;55,\u003csup\u003ec\u003c/sup\u003e 60\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eID, SF, LF\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePROMIS: Depressive Symptoms \u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eT-Score\u0026thinsp;\u0026gt;\u0026thinsp;55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eID, SF, LF\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePROMIS: Depression \u003csup\u003ee\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eT-Score\u0026thinsp;\u0026gt;\u0026thinsp;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eID, SF, LF\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNCCN Distress Thermometer \u003csup\u003eh\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRating\u0026thinsp;\u0026ge;\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eID, SF, LF\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePAT: Patient Problems \u003csup\u003ei\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eScale Score\u0026thinsp;\u0026ge;\u0026thinsp;0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eID, SF, LF\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eNeurocognitive Functioning\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePedsQL: School Functioning \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eScale Score\u0026thinsp;\u0026lt;\u0026thinsp;65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u0026ndash;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eID, SF, LF\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSCQ \u003csup\u003ej\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eItem 1\u0026thinsp;=\u0026thinsp;0 or Item 2\u0026thinsp;=\u0026thinsp;1 \u003csup\u003ek\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eID, SF, LF\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCLDQ: Reading, Math \u003csup\u003ek\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;2.67, 2.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eID, SF, LF\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(-) PRISM \u003csup\u003el\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eID, SF\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePROMIS: Cognitive Function \u003csup\u003em\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eT-Score\u0026thinsp;\u0026lt;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eID, SF\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eCaregiver Adjustment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePAT: Stress Reaction \u003csup\u003ei\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eScale Score\u0026thinsp;\u0026ge;\u0026thinsp;0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eID, SF, LF\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePAT: Family Beliefs \u003csup\u003ei\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eScale Score\u0026thinsp;\u0026ge;\u0026thinsp;0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eID, SF, LF\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNCCN Distress Thermometer \u003csup\u003eh\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRating\u0026thinsp;\u0026ge;\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eID, SF, LF\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eFamily Factors\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePAT: Family Problems \u003csup\u003ei\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eScale Score\u0026thinsp;\u0026ge;\u0026thinsp;0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eID, SF, LF\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePAT: Sibling Problems \u003csup\u003ei\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eScale Score\u0026thinsp;\u0026ge;\u0026thinsp;0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eID, SF, LF\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eResources\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePAT: Social Support \u003csup\u003ei\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eScale Score\u0026thinsp;\u0026ge;\u0026thinsp;0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eID, SF, LF\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePAT: Transit/Money Problems \u003csup\u003en\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIf\u0026thinsp;\u0026ge;\u0026thinsp;1 Problem Endorsed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eID, SF, LF\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNCCN Problem List: Practical Concerns \u003csup\u003eh\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIf\u0026thinsp;\u0026ge;\u0026thinsp;1 Concern Endorsed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eID, SF, LF\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eAbbreviations\u003c/span\u003e: PT \u003cem\u003e(Patient)\u003c/em\u003e, CGR \u003cem\u003e(Caregiver)\u003c/em\u003e, ID \u003cem\u003e(initial diagnosis, 4\u0026ndash;6 months post-diagnosis)\u003c/em\u003e, SF \u003cem\u003e(short-term follow-up, 18\u0026ndash;24 months post-diagnosis)\u003c/em\u003e, LF \u003cem\u003e(long-term follow-up, 4\u0026ndash;6 years post-diagnosis/survivorship)\u003c/em\u003e, (+) measure added via adaptation; (-) measure removed via adaptation.\u003c/p\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eMeasures\u003c/span\u003e:\u003c/p\u003e \u003cp\u003ea Symptom Screening in Pediatrics [Flagged for Follow-Up if\u0026thinsp;\u0026ge;\u0026thinsp;1 symptom was rated as bothering patient \u0026lsquo;A lot\u0026rsquo; (4) or \u0026lsquo;Extremely\u0026rsquo; (5)]\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eb PROMIS Short Form v1.0 \u0026ndash; Self-Efficacy for Managing Medications and Treatment 8a)\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003ec Pediatric Quality of Life Inventory v4.0 \u0026ndash; Parent Report for Toddlers [ages 2\u0026ndash;4]\u003csup\u003e37\u003c/sup\u003e\u003c/p\u003e \u003cp\u003ed PROMIS Pediatric-25 Profile v2.0 (Patients 11\u0026ndash;17); PROMIS Parent Proxy-25 Profile v2.0 (Proxy 5\u0026ndash;17)\u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003ee PROMIS-29 Profile v2.1 (Patients\u0026thinsp;\u0026ge;\u0026thinsp;18)\u003csup\u003e39\u003c/sup\u003e\u003c/p\u003e \u003cp\u003ef PROMIS Pediatric Short Form v1.0 \u0026ndash; Sleep Disturbance 4a (Patients 11\u0026ndash;17); PROMIS Parent Proxy Short Form v1.0 \u0026ndash; Sleep Disturbance 4a (Proxy 5\u0026ndash;17)\u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e,\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eg PROMIS Pediatric Short Form v1.0 \u0026ndash; Physical Activity 4a (Patients\u0026thinsp;\u0026ge;\u0026thinsp;11); PROMIS Parent Proxy Short Form v1.0 \u0026ndash; Physical Activity 4a (Proxy 5\u0026ndash;17)\u003csup\u003e\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eh National Comprehensive Cancer Network v1.2022 \u0026ndash; Distress Management\u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003ei Psychosocial Assessment Tool (adapted all-literacy\u0026ndash;all ages version, 2019)\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003ej School Concern Questionnaire [Flagged for Follow-Up if Item 1: \u003cem\u003e\u0026ldquo;My child is currently meeting their academic potential\u0026rdquo;\u003c/em\u003e = \u0026lsquo;No\u0026rsquo; (0) or Item 2: \u003cem\u003e\u0026ldquo;My child needs more educational support to be successful\u0026rdquo;\u003c/em\u003e = \u0026lsquo;Yes\u0026rsquo; (1)]\u003csup\u003e\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003ek Colorado Learning Difficulties Questionnaire\u003csup\u003e\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003el Problem Recognition in Illness Self-Management\u003csup\u003e\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003em PROMIS Pediatric Short Form v1.0 \u0026ndash; Cognitive Function 7a (Patients 11\u0026ndash;17);\u003csup\u003e36\u003c/sup\u003e PROMIS Parent Proxy Short Form v1.0 \u0026ndash; Cognitive Function 7a (Proxy 8\u0026ndash;17);\u003csup\u003e36\u003c/sup\u003e PROMIS Short Form v2.0 \u0026ndash; Cognitive Function 8a (Patients\u0026thinsp;\u0026ge;\u0026thinsp;18)\u003csup\u003e38,39\u003c/sup\u003e\u003c/p\u003e \u003cp\u003en Two items (\u003cem\u003e\u0026ldquo;How will you or other caregivers get to the hospital of clinic?\u0026rdquo;\u003c/em\u003e and \u003cem\u003e\u0026ldquo;In what areas are there money problems?\u0026rdquo;)\u003c/em\u003e from the PAT: Structure/Resources scale\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003ePatient population\u003c/b\u003e. Patients were identified via an EHR report based on cancer date of diagnosis and filtered by screening timepoints: 4\u0026ndash;6 months post-diagnosis (Initial Diagnosis), 18\u0026ndash;24 months post-diagnosis (Short-Term Follow-Up), and 4\u0026ndash;6 years post-diagnosis (Long-Term Follow-Up) and preferred language (English, Spanish, Arabic, Other). Patients aged\u0026thinsp;\u0026ge;\u0026thinsp;11 years and caregivers of patients 0\u0026ndash;17 years were invited to complete surveys via an EHR patient portal message (MyChart) one week prior to a scheduled outpatient appointment falling within the relevant screening window. Patients completed self-report measures, and Caregivers completed self- and proxy-report measures. Surveys were distributed at each timepoint regardless of completion at prior timepoints.\u003c/p\u003e \u003cp\u003e \u003cb\u003eScreening measures\u003c/b\u003e. Measures were selected based on review of the literature,\u003csup\u003e6\u003c/sup\u003e feedback from our interdisciplinary workgroup and community partners about priorities for assessment, consideration of patient/caregiver burden, appropriateness for the age groups, utility in childhood cancer populations, and actionability of response to identified needs (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). For each measure, validation-based cut-points were used to determine results warranting follow-up.\u003c/p\u003e \u003cp\u003e \u003cb\u003eScreening documentation\u003c/b\u003e. A templated care coordination note was developed to route screening results to the medical clinician scheduled for the patient\u0026rsquo;s next appointment and to the social work EHR pool for the patient\u0026rsquo;s social worker. The note included a score summary table across measures/domains indicating areas requiring follow-up versus no concerns. Separate templated smart phrases for follow-up documentation were developed for the medical and social work teams. Social work documentation also included pre-defined fields to capture services offered, intervention intensity, and time spent on follow-up.\u003c/p\u003e \u003cp\u003e \u003cb\u003eImplementation strategies\u003c/b\u003e. Implementation was optimized using evidence-informed strategies catalogued through the Expert Recommendations for Implementing Change (ERIC) project:\u003csup\u003e23\u003c/sup\u003e screening champions; patient, caregiver, and clinician education; minimization of screening burden; and language accessibility. Clinical leaders\u0026mdash;medical directors and psychosocial managers\u0026mdash;acted as champions by participating in program development, providing feedback, and promoting implementation. Clinician education regarding program purpose, response to screening results (Blueprint for Care; Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), and documentation expectations was offered during standing meetings and scheduled sessions, and through real-time clinical review and documentation. Standard operating procedures were developed for medical, social work, and screening teams. Patient/caregiver education on the screening program was provided through existing newly diagnosed family education and flyers. To minimize screening burden, surveys were sent one week prior to a scheduled clinic visit. Reminders were sent via MyChart and by phone if screening was incomplete within a few days of the appointment. Between June 2023\u0026ndash;November 2024, patients/caregivers without MyChart access or who did not complete screening prior to their appointment were offered portal registration and/or in-clinic completion via iPad; this process was discontinued (see Results). Our hospital\u0026rsquo;s Language Services translated measures and screening program communications/instructions if translated measures did not exist.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eImplementation Evaluation and Outcomes\u003c/h3\u003e\n\u003cp\u003eEvaluation was comprised of: (1) \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eAdoption\u003c/span\u003e: Overall rate of screening completion by timepoint, mode of completion, language, and site; (2) \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eFeasibility\u003c/span\u003e: EHR documentation that results were delivered to clinicians; (3) \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ePenetration\u003c/span\u003e: EHR documentation that patient-caregiver-clinician communication and follow-up occurred as indicated in the in medical and social work progress notes; (4) \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eSustainability\u003c/span\u003e: Acceptability ratings from patients and caregivers collected via screening\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e and data on satisfaction through patient, caregiver, and clinician interviews; (5) \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eAdaptations\u003c/span\u003e: Changes made based on review of outcomes, data related to (1)-(4), were continuously tracked (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e\u003cb\u003eQualitative Interviews\u003c/b\u003e. An interview guide, informed by the Consolidated Framework for Implementation Research (CFIR)\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e and developed in partnership with the working group, evaluated acceptability, screening barriers, impact on care, and implementation strategies among patients and caregivers who completed screening. Approximately one-month post-screening, with interpreter support as needed, patients and caregivers were invited to participate in a structured phone interview using the interview guide and responses were recorded in REDCap.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e Clinicians of patients and caregivers who completed screening were emailed a REDCap\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e survey with open-ended questions about workflow integration, impact on patient/caregiver communication, and implementation strategies based on the interview guide. The screening team analyzed patient and caregiver responses inductively by question, with frequencies of perspectives across CFIR domains recorded. Clinician responses were coded as barriers to implementation and effective implementation strategies, with code counts recorded.\u003c/p\u003e \u003cp\u003e \u003cb\u003eAdaptations.\u003c/b\u003e During implementation, patient, caregiver, and clinician and screening team feedback was regularly reviewed to inform adaptations (i.e., modifications to the program and strategies to address identified barriers). \u003cem\u003eAdaptations\u003c/em\u003e were recorded in real time in a spreadsheet indicating the modification, date of modification, problem addressed, and its data source.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eStarting in June 2023, the psychosocial screening program rolled out in phases for patient populations, languages, and sites (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA\u003cem\u003edoption, Feasibility, and Penetration\u003c/em\u003e\u003c/p\u003e \u003cp\u003eAs of November 2025, 846 surveys were sent to patients (n\u0026thinsp;=\u0026thinsp;306) and caregivers (n\u0026thinsp;=\u0026thinsp;540) across timepoints, with 470 (56%) completed overall (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), representing 380 unique patients. Nineteen caregivers and 4 patients completed screening in Spanish, and 3 caregivers in Arabic. As expected, screening was primarily distributed and completed at the main site and with hematologic malignancies (first implementation phase, largest cancer center population).\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAdoption\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eInitial Diagnosis, n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eShort-Term Follow-Up, n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eLong-Term Follow-Up, n (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatient\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCaregiver\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePatient\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCaregiver\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePatient\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCaregiver\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSurveys Completed\u003c/b\u003e\u0026dagger;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51/92 (55%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e129/195 (66%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e67/132 (51%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e144/243 (59%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e30/82 (37%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e49/102 (48%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePatient Age Group\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0‒10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81 (63%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95 (66%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e28 (57%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11‒17 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40 (78%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48 (37%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40 (60%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e49 (34%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e15 (50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e21 (43%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;18 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27 (40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e15 (50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMode of Completion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRemotely via MyChart\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (43%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77 (60%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e47 (70%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e106 (74%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e22 (73%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e39 (80%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn Clinic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (57%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52 (40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20 (30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e38 (26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8 (27%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e10 (20%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLanguage\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnglish\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49 (96%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e120 (93%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e66 (99%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e133 (92%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e29 (97%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e47 (96%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpanish\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10 (7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1 (3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2 (4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArabic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSite\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMain Hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44 (86%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e101 (78%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e49 (73%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e109 (76%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e21 (70%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e35 (71%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKOP Specialty Care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14 (21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21 (14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e10 (20%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVNJ Specialty Care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4 (8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eService\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHematologic Malignancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65 (50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40 (60%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e86 (60%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e17 (57%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e31 (63%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSolid Tumors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (53%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55 (43%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27 (40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e54 (37%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e12 (40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e14 (29%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrain Tumors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1 (3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4 (8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDomains Flagged for Follow-Up\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient Cancer-related Symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4/20 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24/72 (33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15/46 (33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19/95 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient Medication Management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3/10 (30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5/25 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2/15 (13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient Physical Quality of Life\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40/51 (78%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84/117 (72%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e32/67 (48%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e76/141 (54%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10/30 (33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e34/49 (69%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient Social Quality of Life\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7/51 (14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19/116 (16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9/66 (14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e27/141 (19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2/29 (7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e11/49 (22%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient Emotional Functioning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25/51 (49%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81/129 (63%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28/67 (42%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e52/144 (36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9/29 (31%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e17/49 (35%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient Neurocognitive Functioning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0/1 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37/82 (45%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14/65 (22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e59/121 (49%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6/28 (21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e23/46 (50%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCaregiver Adjustment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74/128 (58%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e53/143 (37%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e25/49 (51%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily Factors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18/128 (14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21/140 (15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e7/47 (15%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResource Needs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4/10 (40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62/128 (48%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14/25 (56%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e60/141 (43%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8/15 (53%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e9/48 (19%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"9\" nameend=\"c9\" namest=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eNote.\u003c/span\u003e Percentages may not equal 100 due to rounding. Survey measures were completed only by eligible respondents (per validation criteria: age; patient/caregiver); denominators vary by domain.\u003c/p\u003e \u003cp\u003e\u0026dagger; Patient Age Group, Mode of Completion, Language, Site, Service, and Domains Flagged for Follow-Up are reported for completed surveys only.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAt initial diagnosis, 55% of patients and 66% of caregivers completed screening, with 43% and 60% via MyChart and 96% and 93% in English respectively. The most frequently endorsed clinical concerns (flagged for follow-up) for patients were Physical Quality of Life (78%), Emotional Functioning (49%), and Resource Needs (40%), and for caregivers, their child\u0026rsquo;s Physical Quality of Life (72%) and Emotional Functioning (63%), and Caregiver Adjustment (58%). At short-term follow-up, 51% of patients and 59% of caregivers completed screening, with 70% and 74% via MyChart and 99% and 92% in English respectively. The most frequently endorsed concerns for patients were Physical Quality of Life (48%), Emotional Functioning (42%), and Resource Needs (56%) and for caregivers, their child\u0026rsquo;s Physical Quality of Life (54%) and Neurocognitive Functioning (49%), and Resource Needs (43%). At long-term follow-up, 37% of patients and 48% of caregivers completed screening, with 73% and 80% via MyChart and 97% and 96% in English respectively. The most frequently endorsed concerns for patients were Physical Quality of Life (33%), Emotional Functioning (31%), and Resource Needs (53%) and for caregivers, their child\u0026rsquo;s Physical Quality of Life (69%) and Neurocognitive Functioning (50%) and Caregiver Adjustment (51%).\u003c/p\u003e \u003cp\u003eMedical clinicians had a documentation rate of 34% (n\u0026thinsp;=\u0026thinsp;129/376) of which 93% (n\u0026thinsp;=\u0026thinsp;120) indicated screening results were discussed with the family and 7% (n\u0026thinsp;=\u0026thinsp;9) indicated results were not discussed. The social work team had a documentation rate of 74% (n\u0026thinsp;=\u0026thinsp;279/376). Among completed notes, 4% (n\u0026thinsp;=\u0026thinsp;10) documented attempted contact but were unable to reach the family, 30% (n\u0026thinsp;=\u0026thinsp;85) indicated no follow-up was needed [of which 78% (n\u0026thinsp;=\u0026thinsp;66) documented professional collaboration], 4% (n\u0026thinsp;=\u0026thinsp;10) reported the social work team was already engaged with family, and 62% (n\u0026thinsp;=\u0026thinsp;174) documented interventions. Interventions included Social Work Assessment and Intervention (89%; n\u0026thinsp;=\u0026thinsp;155), Financial Assessment and Resource Referral (33%; n\u0026thinsp;=\u0026thinsp;57), and Care Coordination and Interdisciplinary Intervention (23%; n\u0026thinsp;=\u0026thinsp;40). (Percentages reflect the proportion of patients receiving each intervention type; and therefore, do not sum to 100%.) The average duration of interventions was 32.7 (SD\u0026thinsp;=\u0026thinsp;15.6) minutes, with acuity of 1 (8%), 2 (50%), and 3 (42%), with 3 indicating the highest acuity.\u003c/p\u003e\n\u003ch3\u003eAcceptability\u003c/h3\u003e\n\u003cp\u003eOn the acceptability rating scale (1\u0026thinsp;=\u0026thinsp;strongly disagree to 5\u0026thinsp;=\u0026thinsp;strongly agree), average caregiver and patient ratings respectively for (1) \u003cem\u003e\u0026ldquo;Completing the survey prior to or during my clinic visit worked well\u0026rdquo;\u003c/em\u003e (Mean\u0026thinsp;=\u0026thinsp;3.7/5, 3.8/5) and (2) \u003cem\u003e\u0026ldquo;The amount of time it took to complete the survey was okay\u0026rdquo;\u003c/em\u003e (Mean\u0026thinsp;=\u0026thinsp;3.5/5, 3.8/5) indicated moderate acceptability. Ratings for both items and for caregivers and patients, respectively, were lowest at initial diagnosis [Mean(1)\u0026thinsp;=\u0026thinsp;3.7, 3.8; Mean(2)\u0026thinsp;=\u0026thinsp;3.5, 3.5], higher at short-term follow-up [Mean(1)\u0026thinsp;=\u0026thinsp;3.7, 3.8; Mean(2)\u0026thinsp;=\u0026thinsp;3.6, 3.8], and highest at long-term follow-up [Mean(1)\u0026thinsp;=\u0026thinsp;3.9, 4.1; Mean(2)\u0026thinsp;=\u0026thinsp;3.7, 4.1].\u003c/p\u003e \u003cp\u003eFor patient/caregiver interviews, responses to each question fell into contrasting perspectives across CFIR domains, with 90% indicating that the survey was easy to complete, 79% that the length was acceptable, 83% that they understood the screening program and its goals, and 52% that the screening helped them communicate their needs to their health care team (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Although most (61%) patients/caregivers viewed the Cancer Center as a resource prior to screening, for 39% screening increased their awareness of ways the Cancer Center supports families and about a quarter believed screening changed their interactions with and resources received from their team.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFrequencies of Patient and Caregiver Interview Codes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"15\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eInterview Themes and Codes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eYear 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eYear 2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c12\" namest=\"c10\"\u003e \u003cp\u003eYear 3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003eYears 1\u0026ndash;3\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ePT\u003c/span\u003e \u003c/p\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eCGR\u003c/span\u003e\u003c/p\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eTOTAL\u003c/span\u003e\u003c/p\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ePT\u003c/span\u003e\u003c/p\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eCGR\u003c/span\u003e\u003c/p\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eTOTAL\u003c/span\u003e\u003c/p\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ePT\u003c/span\u003e\u003c/p\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eCGR\u003c/span\u003e\u003c/p\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eTOTAL\u003c/span\u003e\u003c/p\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c14\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c15\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eOPSP Survey Experience\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurvey was Easy to Complete/Comprehensive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e96%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e80%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e92%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e90%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurvey was Difficult to Complete\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e20%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e10%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOPSP Survey Length\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurvey Length was Acceptable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e82%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e63%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e82%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e79%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurvey Length was Not Acceptable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e27%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e18%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e21%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation and Communication about OPSP\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSufficient Communication/Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e86%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e93%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e67%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e83%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDid Not Have Sufficient Communication/Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e33%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e17%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eModes of Communicating Needs\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerceived Advantages to Communicating Needs via Survey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e29%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e58%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e42%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo Difference Between Survey/Sharing Directly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e14%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e25%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e13%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreference for Direct Communication with Care Team\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e57%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e17%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e46%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eImpact of OPSP on Identifying/Communicating Needs\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHelped Identify/Communicate Needs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e54%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e75%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e52%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDid Not Help Identify/Communicate Needs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e46%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e25%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e48%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eImpact of OPSP on Interactions with Care Team\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFacilitated or Enhanced Care Team Interactions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e17%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e33%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e26%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo Change in Interactions with Care Team\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e83%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e67%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e74%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eImpact of OPSP on Family Resources\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnhanced Access to or Awareness of Resources\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e38%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e45%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e29%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDid not Change Resources for Family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e86%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e62%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e55%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e71%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eImpact of OPSP on the Cancer Center as a Resource\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStrengthened Perception of Cancer Center as a Resource\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e36%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e62%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e39%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerception Remained Positive and Unchanged\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e74%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e64%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e38%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e61%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCancer Center Responsiveness to Family Needs/Strengths\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSuggestions to Improve Support for Families\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e33%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e30%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent Support Adequately Meets Family Needs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e90%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e67%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e70%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"15\" nameend=\"c15\" namest=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eAbbreviations\u003c/span\u003e: OPSP (Onco Psychosocial Screening Program), PT (Patient), CGR (Caregiver)\u003c/p\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eNote.\u003c/span\u003e Frequencies reflect coded responses from n\u0026thinsp;=\u0026thinsp;7 patients (PT) and n\u0026thinsp;=\u0026thinsp;45 caregivers (CGR) across Year 1 (2023), Year 2 (2024), and Year 3 (2025). Percentages were calculated using question-specific denominators (i.e., the number of participants who responded to each item). Because not all participants answered every question, n varies by item. \u0026ldquo;Total\u0026rdquo; represents aggregated frequencies across Years 1\u0026ndash;3.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\u003cp\u003eResponses from oncologists, nurse practitioners, and social workers reflected more positive feedback on implementation strategies (112 coded responses) than barriers (66 coded responses). Identified barriers were impact on workflow (81%), having access to specific screening responses to guide follow-up (8%), uncertainty of value added (8%), and potential burden of survey completion on patients/caregivers (3%). However, clinicians also highlighted effective implementation strategies from initiation through adaptions: the Cancer Center valuing universal psychosocial screening (35%), timely receipt of screening results (23%), easy-to-access/understandable results (19%), preparation/education on how to review and follow-up on screening results with patients/caregivers (17%), and screening created additional ways to communicate with patients/caregivers about needs and concerns (6%).\u003c/p\u003e\n\u003ch3\u003eAdaptations and Sustainability\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eAmong 55 adaptations, 45 (82%) were made to five components of the screening program: education, administrative workflow, screening assessment and user interface, clinical workflow, and sustainability. \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eEducation\u003c/span\u003e adaptations (9%, n\u0026thinsp;=\u0026thinsp;5) included changes to education/training (e.g., 1:1 education for new clinicians or those unable to attend scheduled sessions). \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eScreening administrative workflow\u003c/span\u003e (18%, n\u0026thinsp;=\u0026thinsp;8) adaptations focused on operational processes (e.g., adjusted timing for sending surveys to patients/caregivers prior to scheduled appointments). \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eScreening assessment/user interface\u003c/span\u003e (36%, n\u0026thinsp;=\u0026thinsp;16) adaptations consisted of changes to the screening surveys, interface with families, or timing (e.g., added SSPedi\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e for relevance to clinical care; removed redundant measures of physical quality of life and neurocognition to reduce burden; added open-ended \u0026lsquo;agenda setting\u0026rsquo; questions on current concerns). \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eClinical workflow\u003c/span\u003e (18%, n\u0026thinsp;=\u0026thinsp;8) adaptations involved changes to clinical processes (e.g., added interventions to social work note template to ease documentation burden; updated score summary reports to provide specific information on screening survey responses). \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eSustainability\u003c/span\u003e (18%, n\u0026thinsp;=\u0026thinsp;8) adaptations were made to promote long-term program continuity (e.g., developed a more efficient EHR-based patient eligibility report; built automated alerts to screening team regarding screening initiation/completion; and discontinued in-clinic completion due to limited feasibility across sites and missed same-day results within clinical workflows). Changes were also made to tracking logs, databases, and interviews to improve \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003equality improvement project workflow\u003c/span\u003e (18%, n\u0026thinsp;=\u0026thinsp;10).\u003c/p\u003e \u003c/div\u003e "},{"header":"Discussion","content":"\u003cp\u003e Consistent with the Psychosocial Standards of Care in Childhood Cancer, using rigorous quality improvement processes, we achieved development, implementation, and modification of a psychosocial screening program across our large cancer center. Patients, caregivers, and clinicians generally reported that screening was acceptable, providing an additional, important opportunity to share needs and access resources. Screening prompted discussions with patients/families and increased multidisciplinary collaboration, both for follow-up required and \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eno\u003c/span\u003e follow-up required. However, patients and caregivers highlighted the need for a shorter screening, and challenges occurred in fully integrating screening processes into the EHR. Our quality improvement process of phased implementation and applying REAM\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e allowed for ongoing review and modification of the program over time to address barriers as they were identified, potentially improving our implementation outcomes.\u003c/p\u003e \u003cp\u003eTo meet the Standards, children\u0026rsquo;s cancer programs that aim to establish screening programs face barriers to universal screening depending on program characteristics (e.g., size, hospital and community resources), culture around patient/family assessments, and flexibility of the EHR. Continual review of feedback and real-time adaptations guided by REAM\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e were critical to achieving our aims. Although large in terms of patient population size, complexity, and geography, characteristics of our Cancer Center (e.g., integrated, multidisciplinary psychosocial services) presented opportunities to identify and address multilevel implementation barriers, sufficient staffing to respond to identified needs, and experience with multidisciplinary partnerships around innovative programming. In addition, our screening team included Cancer Center leaders who championed the screening program and fostered buy-in to improve access to care. These factors enabled significant progress toward universal screening and helped establish processes that can serve as a model for other children\u0026rsquo;s cancer programs.\u003c/p\u003e \u003cp\u003eAttention to barriers at the patient/caregiver and program/institution levels generated screening implementation strategies generalizable to other children\u0026rsquo;s cancer programs.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e,\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e The multilevel implementation strategies based on ERIC\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e (language accessibility, education on value of screening for all involved, ensuring communication with patients/caregivers and among the multidisciplinary team about screening results, attention to burden and workflow, screening champions) are consistent with those noted in other studies of psychosocial screening in childhood cancer,\u003csup\u003e12,14,28\u003c/sup\u003e as well as in a recent systematic review on implementing patient-reported outcomes in adult oncology.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e Not all barriers were fully addressed, and some barriers (e.g., impact of workflow barriers on patient-caregiver-clinician communication and documentation) represent significant challenges to achieving universal screening. Across implementation phases, and with expansion to most patients, the screening team experienced increasing workload for which we tracked time and effort and made adaptations to automate more processes.\u003c/p\u003e \u003cp\u003ePsychosocial screening integrated into the EHR remains a goal as does the need to optimize workflow efficiencies to reduce clinical and screening staff demands and support sustainability. Related to EHR integration, the social work team achieved high rates of documented follow-up and multidisciplinary collaboration. In contrast, limited medical clinician documentation indicates that more can be done to leverage the EHR to facilitate screening workflow. At our center, we continue to pursue full EHR integration of psychosocial screening facilitated by improved visit scheduling, diagnosis documentation, and treatment end-date tracking in the EHR. While using REDCap\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e allows us to administer screening surveys across timepoints, disease groups, sites, timepoints, and languages as well as analyze, refine, and optimize the program in real time, retaining all other program components in the EHR (screening invites, results communication, etc.) will allow for the eventual, seamless transition to fully EHR-based screening.\u003c/p\u003e \u003cp\u003eFor this screening program, we were able to partner with the CHOP\u0026rsquo;s Language Services for accurate, reliable translation of measures, instructions, and communications in Spanish and Arabic, and the interpreter team facilitated conversations with families to follow up on screening. Screening in the languages most commonly used in children\u0026rsquo;s cancer programs in the United States is important given the number of patients/families who speak languages other than English and emerging data regarding health inequities in childhood cancer outcomes.\u003csup\u003e\u003cspan additionalcitationids=\"CR30\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e Caregivers who speak languages other than English may have difficulties fully understanding medical consent, expressing concerns related to their sociocultural contexts, and accessing the resources available to them.\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e There are significant disparities in cancer care and outcomes for Hispanic children who are less likely to participate in research\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e or receive follow-up care,\u003csup\u003e34\u003c/sup\u003e and they are at risk for parental psychological difficulties.\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e Spanish-speaking caregivers in the United States believe their child would have received better cancer care if they spoke English, and language barriers can impact how families engage in care.\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThis report of lessons learned in establishing a psychosocial screening program can facilitate implementation of the Psychosocial Standards of Care. We acknowledge that we had resources to rigorously launch, continuously evaluate, and make modifications to implementation strategies. Nevertheless, identified facilitators and strategies that support sustainability, such as reducing measure redundancies and automating screening processes, are applicable across children\u0026rsquo;s cancer programs. Ultimately, findings have the potential to inform sustainable implementation of comprehensive, evidence-based, screening in multiple languages at key transitions in cancer treatment towards the goal of improved access to and engagement in care.\u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eFunded by\u003c/strong\u003e \u003cp\u003eProgram implementation was funded by Pfizer Medical Program Grants/PROTEUS Learning Health Network.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003e \u003cem\u003eCompeting Interests\u003c/em\u003e:\u003c/strong\u003e \u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e \u003ch2\u003e \u003cem\u003eEthics approval\u003c/em\u003e:\u003c/h2\u003e \u003cp\u003e This research study was conducted retrospectively from data obtained for clinical purposes and in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments. The Children\u0026rsquo;s Hospital of Philadelphia Institutional Review Board approval was granted to allow for dissemination (CHOP IRB 24-022574).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003e \u003cem\u003eConsent to participate\u003c/em\u003e:\u003c/strong\u003e \u003cp\u003eNot applicable due to retrospective study.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003e \u003cem\u003eConsent to publish\u003c/em\u003e:\u003c/strong\u003e \u003cp\u003eNot applicable due to retrospective study.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors contributed to study conception and design. Material preparation, data collection, and analysis were performed by Susanna Vargo, Shannon Hammer, and Lamia Barakat. The first draft of the manuscript was written by Lamia Barakat, Shannon Hammer, Susanna Vargo, and Megan Perez. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003e We thank members of the working group, Chelsea Apple, LSW, Iris Paltin, PhD, ABPP-CN, Massiel Ortega Rivera, Tayseer Said, survivor and caregiver advisors, clinical research coordinators (Ashley Anil, Laylah Jones, Nithyasri Ramaswamy), and screening program staff (Cailin Shallow, Kishori Shah). Portions of this paper were presented at the Society of Pediatric Psychology Annual Conference, Phoenix, AZ, 2025 and the 4th Eastern and Northern European Childhood Cancer Conference, Bratislava, Slovakia, 2025. The PROM-GRIP reporting requirements document was used in preparing this study as part of a pilot trial of its utility.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAdler, N. E., Page, A. E. K., \u0026amp; Institute of Medicine (US) Committee on Psychosocial Services to Cancer Patients/Families in a Community Setting (Eds.). (2008). \u003cem\u003eCancer Care for the Whole Patient: Meeting Psychosocial Health Needs\u003c/em\u003e. National Academies Press (US). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.17226/11993\u003c/span\u003e\u003cspan address=\"10.17226/11993\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSharara M, Tjioe KC, Miranda-Galvis M, Santellano Juarez B, Agrawal G, Balas EA, Johnson TS, Cortes JE (2024) Social determinants of health impact on cancer affecting children, adolescents, and young adults: systematic review and meta-analysis. Front Adolesc Med 2:1441776. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fradm.2024.1441776\u003c/span\u003e\u003cspan address=\"10.3389/fradm.2024.1441776\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWiener L, Kazak AE, Noll RB, Patenaude AF, Kupst MJ (2015) Standards for the psychosocial care of children with cancer and their families: an introduction to the special issue. \u003cem\u003ePediatr Blood Cancer\u003c/em\u003e 62(Suppl 5):S419\u0026ndash;S424. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/pbc.25675\u003c/span\u003e\u003cspan address=\"10.1002/pbc.25675\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKazak AE, Scialla M, Deatrick JA, Barakat LP (2024) Pediatric psychosocial preventative health model: achieving equitable psychosocial care for children and families. \u003cem\u003eFam Syst Health\u003c/em\u003e 42:76\u0026ndash;89. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1037/fsh0000856\u003c/span\u003e\u003cspan address=\"10.1037/fsh0000856\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKazak AE, Scialla MA, Canter KS, Sardi-Brown V, Buff K, Arasteh K, Pariseau E, Sandler E, Wiener L (2025) Delivering care consistent with the psychosocial standards\u0026mdash;Provider report: Implementing the Standards Together\u0026ndash;Engaging Parents and Providers in Psychosocial Care (iSTEPPP) study. \u003cem\u003ePediatr Blood Cancer\u003c/em\u003e 72:e31959. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/pbc.31959\u003c/span\u003e\u003cspan address=\"10.1002/pbc.31959\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKazak AE, Abrams AN, Banks J, Christofferson J, DiDonato S, Grootenhuis MA, Kabour M, Madan-Swain A, Patel SK, Zadeh S, Kupst MJ (2015) Psychosocial assessment as a standard of care in pediatric cancer. \u003cem\u003ePediatr Blood Cancer\u003c/em\u003e 62(Suppl 5):S426\u0026ndash;S459. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/pbc.25730\u003c/span\u003e\u003cspan address=\"10.1002/pbc.25730\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnnett RD, Patel SK, Phipps S (2015) Monitoring and assessment of neuropsychological outcomes as a standard of care in pediatric oncology. \u003cem\u003ePediatr Blood Cancer\u003c/em\u003e 62(Suppl 5):S460\u0026ndash;S513. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi-org.proxy.library.upenn.edu/\u003c/span\u003e\u003cspan address=\"https://doi-org.proxy.library.upenn.edu/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/pbc.25749\u003c/span\u003e\u003cspan address=\"10.1002/pbc.25749\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePelletier W, Bona K (2015) Assessment of financial burden as a standard of care in pediatric oncology. \u003cem\u003ePediatr Blood Cancer\u003c/em\u003e 62(Suppl 5):S619\u0026ndash;S631. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi-org.proxy.library.upenn.edu/\u003c/span\u003e\u003cspan address=\"https://doi-org.proxy.library.upenn.edu/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/pbc.25714\u003c/span\u003e\u003cspan address=\"10.1002/pbc.25714\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKearney JA, Salley CG, Muriel AC (2015) Standards of psychosocial care for parents of children with cancer. \u003cem\u003ePediatr Blood Cancer\u003c/em\u003e 62(Suppl 5):S632\u0026ndash;S683. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi-org.proxy.library.upenn.edu/\u003c/span\u003e\u003cspan address=\"https://doi-org.proxy.library.upenn.edu/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/pbc.25761\u003c/span\u003e\u003cspan address=\"10.1002/pbc.25761\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKazak AE, Schneider S, DiDonato S, Pai AL (2015) Family psychosocial risk screening guided by the Pediatric Psychosocial Preventative Health Model (PPPHM) using the Psychosocial Assessment Tool (PAT). \u003cem\u003eActa Oncol\u003c/em\u003e 54:574\u0026ndash;580. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3109/0284186X.2014.995774\u003c/span\u003e\u003cspan address=\"10.3109/0284186X.2014.995774\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePierce L, Hocking MC, Schwartz LA, Alderfer MA, Kazak AE, Barakat LP (2017) Caregiver distress and patient health-related quality of life: psychosocial screening during pediatric cancer treatment. \u003cem\u003ePsychooncology\u003c/em\u003e 26:1555\u0026ndash;1561. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/pon.4171\u003c/span\u003e\u003cspan address=\"10.1002/pon.4171\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeatrick JA, Kazak AE, Scialla MA, Madden RE, McDonnell GA, Okonak K, Barakat LP (2022) Advancing health equity in pediatric cancer through implementation of universal family psychosocial risk screening. \u003cem\u003ePsychooncology\u003c/em\u003e 31:1483\u0026ndash;1490. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/pon.5978\u003c/span\u003e\u003cspan address=\"10.1002/pon.5978\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFitzGerald C, Hurst S (2017) Implicit bias in healthcare professionals: a systematic review. \u003cem\u003eBMC Med Ethics\u003c/em\u003e 18:19. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12910-017-0179-8\u003c/span\u003e\u003cspan address=\"10.1186/s12910-017-0179-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKazak AE, Barakat LP, Askins MA, McCafferty M, Lattomus A, Ruppe N, Deatrick J (2017) Provider perspectives on the implementation of psychosocial risk screening in pediatric cancer. \u003cem\u003eJ Pediatr Psychol\u003c/em\u003e 42:700\u0026ndash;710. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/jpepsy/jsw110\u003c/span\u003e\u003cspan address=\"10.1093/jpepsy/jsw110\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKazak AE, Brier M, Alderfer MA, Reilly A, Fooks Parker S, Rogerwick S, Ditaranto S, Barakat LP (2012) Screening for psychosocial risk in pediatric cancer. \u003cem\u003ePediatr Blood Cancer\u003c/em\u003e 59:822\u0026ndash;827. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/pbc.24166\u003c/span\u003e\u003cspan address=\"10.1002/pbc.24166\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKazak AE, Hwang WT, Chen FF, Askins MA, Carlson O, Argueta-Ortiz F, Barakat LP (2018) Screening for family psychosocial risk in pediatric cancer: validation of the Psychosocial Assessment Tool (PAT) version 3. \u003cem\u003eJ Pediatr Psychol\u003c/em\u003e 43:737\u0026ndash;748. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/jpepsy/jsy012\u003c/span\u003e\u003cspan address=\"10.1093/jpepsy/jsy012\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarakat LP, Scialla MA, Ramaswamy N, et al. A comparative effectiveness trial for universal psychosocial screening with the Psychosocial Assessment Tool (PAT) across 18 childhood cancer programs in the United States: adoption, penetration, and health equity. \u003cem\u003eImplement Sci\u003c/em\u003e 2026. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s13012-026-01493-4\u003c/span\u003e\u003cspan address=\"10.1186/s13012-026-01493-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePerez MN, Madden R, Zukin H, Vel\u0026aacute;zquez-Martin BM, Barakat LP (2023) Psychosocial needs of pediatric cancer patients and their caregivers at end of treatment: why psychosocial screening remains important. \u003cem\u003ePediatr Blood Cancer\u003c/em\u003e 70:e30540. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/pbc.30540\u003c/span\u003e\u003cspan address=\"10.1002/pbc.30540\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcNall M, Foster-Fishman PG (2007) Methods of rapid evaluation, assessment, and appraisal. \u003cem\u003eAm J Eval\u003c/em\u003e 28:151\u0026ndash;168. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/1098214007300895\u003c/span\u003e\u003cspan address=\"10.1177/1098214007300895\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmith J, Rapport F, O\u0026rsquo;Brien TA et al (2020) The rise of rapid implementation: a worked example of solving an existing problem with a new method by combining concept analysis with a systematic integrative review. \u003cem\u003eBMC Health Serv Res\u003c/em\u003e 20:449. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12913-020-05289-0\u003c/span\u003e\u003cspan address=\"10.1186/s12913-020-05289-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHarris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O\u0026rsquo;Neal L et al (2019) The REDCap consortium: building an international community of software platform partners. \u003cem\u003eJ Biomed Inform\u003c/em\u003e 95:103208. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jbi.2019.103208\u003c/span\u003e\u003cspan address=\"10.1016/j.jbi.2019.103208\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWiener L, Kupst MJ, Pelletier W, Kazak AE, Thompson AL (2020) Tools to guide the identification and implementation of care consistent with the psychosocial standards of care. \u003cem\u003ePediatr Blood Cancer\u003c/em\u003e 67:e28586. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/pbc.28586\u003c/span\u003e\u003cspan address=\"10.1002/pbc.28586\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePowell BJ, Waltz TJ, Chinman MJ et al (2015) A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project. \u003cem\u003eImplement Sci\u003c/em\u003e 10:21. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s13012-015-0209-1\u003c/span\u003e\u003cspan address=\"10.1186/s13012-015-0209-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLarsen DL, Attkisson CC, Hargreaves WA, Nguyen TD (1979) Assessment of client/patient satisfaction: development of a general scale. \u003cem\u003eEval Program Plann\u003c/em\u003e 2:197\u0026ndash;207. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/0149-7189(79)90094-6\u003c/span\u003e\u003cspan address=\"10.1016/0149-7189(79)90094-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDamschroder LJ, Reardon CM, Widerquist MAO, Lowery J (2022) The updated Consolidated Framework for Implementation Research based on user feedback. \u003cem\u003eImplement Sci\u003c/em\u003e 17:75. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s13012-022-01245-0\u003c/span\u003e\u003cspan address=\"10.1186/s13012-022-01245-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDupuis LL, Johnston DL, Baggott C, Hyslop S, Tomlinson D, Gibson P, Orsey A, Dix D, Price V, Vanan M, Portwine C, Kuczynski S, Spiegler B, Tomlinson GA, Sung L (2018) Validation of the Symptom Screening in Pediatrics Tool in children receiving cancer treatments. \u003cem\u003eJ Natl Cancer Inst\u003c/em\u003e 110:661\u0026ndash;668. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/jnci/djx250\u003c/span\u003e\u003cspan address=\"10.1093/jnci/djx250\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLyu J, Zhang H, Wang H, Liu X, Jing Y, Yin L, Wang A (2024) Facilitators and barriers to implementing patient-reported outcomes in clinical oncology practice: a systematic review based on the Consolidated Framework for Implementation Research. \u003cem\u003eImplement Sci Commun\u003c/em\u003e 5:120. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s43058-024-00654-0\u003c/span\u003e\u003cspan address=\"10.1186/s43058-024-00654-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePaeps M, Scialla MA, Barakat LP, Arasteh K, Kazak AE (2025) Implementing a psychosocial screener in pediatric oncology: perspectives of multidisciplinary clinicians. \u003cem\u003ePsychooncology\u003c/em\u003e 34:e70356. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/pon.70356\u003c/span\u003e\u003cspan address=\"10.1002/pon.70356\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBhatia S (2011) Disparities in cancer outcomes: lessons learned from children with cancer. \u003cem\u003ePediatr Blood Cancer\u003c/em\u003e 56:994\u0026ndash;1002. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/pbc.23078\u003c/span\u003e\u003cspan address=\"10.1002/pbc.23078\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGupta S, Wilejto M, Poe J, Guttman A, Sung L (2014) Low socioeconomic status is associated with worse survival in children with cancer: a systematic review. \u003cem\u003ePLoS One\u003c/em\u003e 9:e89482. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal.pone.0089482\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0089482\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWallner LP, Griggs JJ (2018) Advancing the science of cancer health disparities research. \u003cem\u003eJ Clin Oncol\u003c/em\u003e 36:1\u0026ndash;3. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1200/JCO.2017.76.0496\u003c/span\u003e\u003cspan address=\"10.1200/JCO.2017.76.0496\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSimon C, Zyzanski SJ, Eder M, Raiz P, Kodish ED, Siminoff LA (2003) Groups potentially at risk for making poorly informed decisions about entry into clinical trials for childhood cancer. \u003cem\u003eJ Clin Oncol\u003c/em\u003e 21:2173\u0026ndash;2178. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1200/JCO.2003.03.003\u003c/span\u003e\u003cspan address=\"10.1200/JCO.2003.03.003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZamora ER, Kaul S, Kirchhoff AC, Gwilliam V, Jimenez OA, Morreall DK, Montenegro RE, Kinney AY, Fluchel MN (2016) The impact of language barriers and immigration status on the care experience for Spanish-speaking caregivers of patients with pediatric cancer. \u003cem\u003ePediatr Blood Cancer\u003c/em\u003e 63:2173\u0026ndash;2180. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/pbc.26150\u003c/span\u003e\u003cspan address=\"10.1002/pbc.26150\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMilam JE, Meeske K, Slaughter RI, Sherman-Bien S, Ritt-Olson A, Kuperberg A, Freyer DR, Hamilton AS (2015) Cancer-related follow-up care among Hispanic and non-Hispanic childhood cancer survivors: the Project Forward study. \u003cem\u003eCancer\u003c/em\u003e 121:605\u0026ndash;613. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/cncr.29105\u003c/span\u003e\u003cspan address=\"10.1002/cncr.29105\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMeeske KA, Sherman-Bien S, Hamilton AS, Olson AR, Slaughter R, Kuperberg A, Milam J (2013) Mental health disparities between Hispanic and non-Hispanic parents of childhood cancer survivors. \u003cem\u003ePediatr Blood Cancer\u003c/em\u003e 60:1470\u0026ndash;1477. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/pbc.24527\u003c/span\u003e\u003cspan address=\"10.1002/pbc.24527\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGruber-Baldini AL, Velozo C, Romero S, Shulman LM (2017) Validation of the PROMIS\u0026reg; measures of self-efficacy for managing chronic conditions. Qual Life Res 26:1915\u0026ndash;1924. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s11136-017-1527-3\u003c/span\u003e\u003cspan address=\"10.1007/s11136-017-1527-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVarni JW, Seid M, Kurtin PS (2001) PedsQL 4.0: reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations. \u0026lt;background-color:#CCFF99;ivertical-align:sub;\u0026gt;Med Care\u0026lt;/background-color:#CCFF99;ivertical-align:sub;\u0026gt; 39:800\u0026ndash;812. \u0026lt;background-color:#CFBFB1;uvertical-align:sub;\u0026gt;https://doi.org/10.1097/00005650-200108000-00006\u0026lt;/background-color:#CFBFB1;uvertical-align:sub;\u0026gt;\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHealthMeasures (2018) HealthMeasures disease-specific guide: pediatric cancer. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.healthmeasures.net/images/applications/Health-Measures-Disease-\u003c/span\u003e\u003cspan address=\"https://www.healthmeasures.net/images/applications/Health-Measures-Disease-\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003eSpecific-Guide-Pediatric%20Cancer-2018_10_29.pdf\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHealthMeasures (2022) HealthMeasures disease-specific guide: cancer. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.healthmeasures.net/images/PROMIS/Selecting_Among_Measurement_Systems/Health_Measures_Disease_Specific_Guide_-_Cancer_2022_05_24.pdf\u003c/span\u003e\u003cspan address=\"https://www.healthmeasures.net/images/PROMIS/Selecting_Among_Measurement_Systems/Health_Measures_Disease_Specific_Guide_-_Cancer_2022_05_24.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTucker CA, Bevans KB, Becker BD, Teneralli R, Forrest CB (2020) Development of the PROMIS Pediatric Physical Activity Item Banks. \u003cem\u003ePhys Ther\u003c/em\u003e 100:1393\u0026ndash;1410. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/ptj/pzaa074\u003c/span\u003e\u003cspan address=\"10.1093/ptj/pzaa074\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHaverman L, et al. (2013) Development and validation of the distress thermometer for parents of a chronically ill child. \u0026lt;background-color:#CCFF99;ivertical-align:sub;\u0026gt;J Pediatr\u0026lt;/background-color:#CCFF99;ivertical-align:sub;\u0026gt; 163:1140\u0026ndash;1146.e2. \u0026lt;background-color:#CFBFB1;uvertical-align:sub;\u0026gt;https://doi.org/10.1016/j.jpeds.2013.06.011\u0026lt;/background-color:#CFBFB1;uvertical-align:sub;\u0026gt;\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNorthman L, Morris M, Loucas C, et al (2018) The effectiveness of a hospital-based school liaison program: a comparative study of parental perception of school supports for children with pediatric cancer and neurofibromatosis type 1. \u003cem\u003eJ Pediatr Oncol Nurs\u003c/em\u003e 35:276\u0026ndash;286. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/1043454218765140\u003c/span\u003e\u003cspan address=\"10.1177/1043454218765140\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWillcutt EG, et al. (2011) Colorado Learning Difficulties Questionnaire: validation of a parent-report screening measure. \u0026lt;background-color:#CCFF99;ivertical-align:sub;\u0026gt;Psychol Assess\u0026lt;/background-color:#CCFF99;ivertical-align:sub;\u0026gt; 23:778\u0026ndash;791. \u0026lt;background-color:#CFBFB1;uvertical-align:sub;\u0026gt;https://doi.org/10.1037/a0023290\u0026lt;/background-color:#CFBFB1;uvertical-align:sub;\u0026gt;\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCox, E. D., Fritz, K. A., Hansen, K. W., Brown, R. L., Rajamanickam, V., Wiles, K. E., Fate, B. H., Young, H. N., \u0026amp; Moreno, M. A. (2014). Development and validation of PRISM: a survey tool to identify diabetes self-management barriers. \u003cem\u003eDiabetes research and clinical practice\u003c/em\u003e, \u003cem\u003e104\u003c/em\u003e(1), 126\u0026ndash;135. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.diabres.2014.01.015\u003c/span\u003e\u003cspan address=\"10.1016/j.diabres.2014.01.015\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Childhood Cancer, Health Equity, Implementation Science, Psychosocial Screening, Psychosocial Standards of Care, Survivorship","lastPublishedDoi":"10.21203/rs.3.rs-9202191/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9202191/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e: 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.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: 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.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: 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.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: We achieved development, implementation, and optimization of a psychosocial screening program across our Cancer Center.\u003c/p\u003e","manuscriptTitle":"Implementation of a Universal Psychosocial Screening Program Across the Pediatric Cancer Treatment Trajectory: A Standard of Care","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-13 17:50:03","doi":"10.21203/rs.3.rs-9202191/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-05-05T15:17:48+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-05-05T15:14:15+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-02T05:44:22+00:00","index":"","fulltext":""},{"type":"submitted","content":"Supportive Care in Cancer","date":"2026-03-23T14:54:38+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"9fa15183-6627-4da9-9ea4-071298ac9f56","owner":[],"postedDate":"May 13th, 2026","published":true,"recentEditorialEvents":[{"type":"reviewersInvited","content":"5","date":"2026-05-05T15:17:48+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-05-05T15:14:15+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-13T17:50:03+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-13 17:50:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9202191","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9202191","identity":"rs-9202191","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}