Purpose <p>To provide a preliminary description of the scope and nature of spiritual care services in outpatient oncology settings.</p> Methods <p>Qualitative thematic analysis of data collected from three focus groups with chaplains representing 13 unique cancer centers.</p> Results <p>Eight of 13 chaplain respondents (61.5%) reported that they provided spiritual care exclusively and in a full-time capacity to a cancer center; the remaining 5 (38.5%) had additional inpatient responsibilities. Chaplains visited between 4 and 10 patients per day depending on departmental policies and case acuity. Respondents identified patients for care in a wide variety of ways and described it as a time-intensive aspect of their job. Chaplains noted providing traditional spiritual care and developing innovative strategies/techniques. Most spiritual care relationships were long-term and often focused on medical decision-making. Chaplains commonly faced organizational challenges and identified priorities for strengthening spiritual care integration in outpatient cancer care.</p> Conclusion <p>The results indicate that the provision of spiritual care in cancer centers differs widely, with chaplains frequently facing challenges with system integration. While chaplains consistently strive to build relationships with clinicians and effectively manage clinic workflows, more collaboration and strategic alignment are needed between chaplains, clinicians, and administrators to develop and advocate for outpatient oncology spiritual care.</p>