Abstract Addressing distress is vital in improving cancer outcomes and health-related quality of life, but implementation of distress screening varies widely across institutions, significantly impacting how effectively resources and support are provided. This study evaluates why a single institution’s distress screening program ostensibly failed, but how flexible systems created by clinical and support staff allow continued provision of services in a setting with high needs and limited resources. Methods: Semi-structured qualitative interviews were conducted with 15 stakeholders, representing cancer center clinical and social services staff involved with routine distress screening, from February-May 2025. Interviews were audio-recorded, transcribed and inductively coded using NVivo 15.0 to identify themes and concepts regarding how distress screening is employed at this institution and how patients receive support services. Results: Stakeholders identified barriers to successful implementation of distress screening using the National Comprehensive Cancer Network (NCCN) Distress Thermometer, despite a carefully designed protocol, across multiple domains identified by the Consolidated Framework for Implementation Research (CFIR): 1) lack of adaptation of a universal tool, poorly understood by patients and staff, 2) high-need patients in communities with limited resources and services, 3) institutional resource and personnel constraints, 4) individuals saving face in interactions during stressful life circumstances, through innovative ways of assessing “distress”, and 5) creative solutions for service provision while meeting institutional accreditation requirements. Medical assistants are invested in patient well-being, but feel the current system is not representative and prioritize self-preservation: staying on time and avoiding patient aggression and discomfort. Social services staff receive many referrals outside of the screening system, resulting in sufficient case load despite screening failures. Conclusions: Barriers to implementation and maintenance of this intervention included those cited elsewhere in the literature, as well as obstacles that reflect a unique institutional culture and limits of provider and staff flexibility within a low-resource setting. Organizational complexity and lack of time and resources produce workarounds for staff to complete required and measurable tasks and save face with patients. Understanding distress screening at this institution through the lens of implementation failure, using the CFIR framework, enhances understanding of the ways in which innovations such as the distress thermometer function across diverse settings. These insights create opportunities for implementation of future interventions in ways that better accommodate the needs of involved stakeholders. Citation Format: Stephanie M. Rieder, Ellen M. Burgess, Caroline R. Pecos-Duarte, Laura Barriga, Jenny Mao. Cold reception to a hot topic: Implementation challenges of distress screening in an academic safety net cancer center abstract. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr C061.
Rieder et al. (Thu,) studied this question.