Received: 17 May 2018 Revised: 26 July 2018 Accepted: 27 July 2018 DOI: 10.1002/pbc.27429 Pediatric Blood & Cancer The American Society of Pediatric Hematology/Oncology RESEARCH ARTICLE Perceived benefits of and barriers to psychosocial risk screening in pediatric oncology by health care providers Maru Barrera 1 Sarah Alexander 2 Wendy Shama 3 Denise Mills 3 Leandra Desjardins 1 Kelly Hancock 1 1 Department of Psychology, The Hospital for Sick Children, Toronto, Canada 2 Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada 3 Department of Social Work, The Hospital for Sick Children, Toronto, Canada Correspondence Maru Barrera, PhD, Department of Psychology, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1×8. Email: maru.barrera@sickkids.ca Funding information Canadian Cancer Society Research Institute, Grant/Award Number: #702843 Abstract Background: Although systematic psychosocial screening has been established as a standard of psychosocial care in pediatric oncology, this is not yet widely implemented in clinical practice. Lim- ited information is available regarding the reasons behind this. In this study, we investigated per- ceptions of psychosocial screening by health care providers (HCPs) involved in pediatric cancer care. Methods: Using purposeful sampling, 26 HCPs (11 oncologists, 8 nurses, and 7 social workers) from a large North American pediatric cancer center participated in semistructured interviews. Interviews were recorded and transcribed verbatim. Themes were then derived using content analysis. Results: The themes were organized into perceived benefits of and barriers to psychosocial risk screening, and practical issues regarding implementation. Perceived benefits of screening included obtaining concise documentation of family psychosocial risk, identifying psychosocial factors important to medical treatment, starting a conversation, and triaging patients to psy- chosocial services. Barriers included perceived limited institutional support, commitment, and resources for psychosocial services, limited knowledge and appreciation of existing evidence- based validated tools, concerns about diverse family cultural backgrounds regarding psychoso- cial issues and language proficiency, and HCPs’ personal values regarding psychosocial screening. Finally, practical issues of implementation including training in psychosocial risk screening, when and how to screen were discussed. Conclusions: These findings highlight the importance of addressing HCPs’ perceptions of benefits, barriers, and practical issues regarding implementing psychosocial risk screening. KEYWORDS oncology, pediatric, psychosocial, quality of life 1 INTRODUCTION It is well established that childhood cancer can have adverse psy- chological effects on the whole family. Recently, following extensive and systematic reviews of the literature, and collaborative effort between experts and stakeholders, 15 standards of psychosocial care for children with cancer and their families were developed. 1 Psychosocial screening was established as one of these standards. It states: “youth with cancer and their family members should routinely Abbreviations: DT, distress thermometer; HCP, health care professional; PAT, Psychosocial Assessment Tool; SW, social worker receive systematic assessments of their psychosocial health care needs.” 2 In spite of the strength of the evidence for the psychosocial screen- ing standard, its adoption in clinical practice has been slow. In a sur- vey of Children's Oncology Centers, published in 2012, less than 10% reported using validated psychosocial assessment instruments within the first month of diagnosis. 3 While a more recent survey in the United States did find an increase in the use of validated psychosocial screen- ing tools, 29%, 4 the majority of pediatric oncology leaders (oncolo- gists, psychosocial professionals, and administrators) indicated that psychosocial care was provided when a concern was raised through informal discussion rather than proactively and systematically. 4 Pediatr Blood Cancer. 2018;e27429. c  2018 Wiley Periodicals, Inc. 1 of 6 wileyonlinelibrary.com/journal/pbc https://doi.org/10.1002/pbc.27429