Background and aim <p>Distress screenings have proven to be valid instruments for identifying psychologically distressed cancer patients. However, in order to ensure psycho-oncological care for these patients, current referral processes (from distress screening to psycho-oncological care) need to be optimized. In this study, the perspective of psycho-oncologists should provide insights into existing processes (“common practice”) and enable disruptions in the process to be identified in order to generate “best practice”.</p> Methods <p>In a&#xa0;noninterventional, quantitative, written survey, psycho-oncologists were asked about the initial consultation. The self-designed questionnaire recorded sociodemographic and oncological patient characteristics, questions about the referral process, the consultation process, and the psychological stress and health literacy of patients. The data analysis was carried out using IBM SPSS Statistics&#xa0;Version 28 (IBM Corp., Armonk, NY, USA) in the form of descriptive and analytical statistics A&#xa0;multivariate analysis of variance (MANOVA) tested the interaction of information provision with duration of consultation, stress, and health literacy assessment.</p> Results <p>A total of 1048 initial consultations were assessed by 9 psycho-oncologists. In 72.5% (<i>n</i> = 754) of the consultations, there was no distress screening. According to psycho-oncologists, 27.7% (<i>n</i> = 290) of patients were not informed about the consultation and 79.6% (<i>n</i> = 467) did not receive any written information about psycho-oncology. In 29.0% (<i>n</i> = 303), the referring person remained unknown to the psycho-oncologists. In all, 16.0% (<i>n</i> = 167) of patients refused psycho-oncological support, and 25.3% (<i>n</i> = 263) of patients were assessed by psycho-oncologists as having a&#xa0;low burden. In 63% (<i>n</i> = 650), there was no multidisciplinary communication. There was a&#xa0;correlation F(3, 346) = 7.179, <i>p</i> &lt; 0.001 between low information provision before the consultation and a&#xa0;higher stress and lower health literacy assessment as well as longer consultation duration.</p> Conclusion <p>The results indicate deficits in the referral to psycho-oncological care by means of distress screening. Systematic optimization of the provision of information about psycho-oncology to patients, standards for the application and evaluation of distress screening, and the promotion of multidisciplinary communication appear essential in order to improve the quality of care and reduce incorrect referrals.</p>