Background: This study explored the sustainability of Screening for Distress, a program that facilitates distress management, in two cancer clinics six months post-implementation. Methods: A mixed-method cross-sectional design was utilized. To assess program sustainability and explore the barriers and facilitators of sustainability 184 charts were reviewed and sixteen semi-structured interviews were conducted. Results: 163 (88.6%) charts had completed tools and a conversation about the tool took place in 130 (79.8%) of those. 89 (54.6%) tools warranted an intervention and 68 (76.4%) of those had an intervention documented. Five themes influencing sustainability emerged: attitudes, knowledge and beliefs, outcome expectancy, implementation approach, integration with existing practices, and external factors. Conclusions: This study suggests that screening was largely sustained, possibly due to positive attitudes and outcome expectancy. However, sustainability may be enhanced by formally integrating screening with existing practices, addressing potential knowledge gaps, and ensuring engagement with all stakeholder groups
