PROJECT SUMMARY Rapid advances in oncology research, care delivery and policy have generated new ethical dilemmas for patients, clinicians, scientists, and society. Paradigmatic examples include the biases, interpretability, and professional responsibilities surrounding oncologic applications of artificial intelligence (AI) and conflicts between providing optimal cancer care for individuals when that same care induces climate change and increases global mortality. Recognizing this need, we recently established the Dana-Farber Harvard Cancer Center (DF/HCC) Forum for Oncology Bioethics Research. This group of bioethics-trained physician scientists meets monthly to discuss bioethics research proposals, analyses, grants, and potential collaborations. While this forum has led to nascent collaborations and several grant proposals and manuscripts, a formalized initiative with outside guidance and long-term strategic planning is required to effectively direct research on the ethical dilemmas oncology faces. Our objective is to develop this infrastructure through the DF/HCC, leveraging the input of internal and external stakeholders to construct strategic and operating plans, and performing a pilot process initiative through two data-generating projects on artificial intelligence and environmental oncology. In Aim 1, we propose to develop strategic and operating plans for a formal cancer bioethics research initiative. Drawing on an adapted Kaplan-Norton strategy management paradigm for research programs, we will solicit input from internal and external stakeholders to prioritize bioethics research topics, identify existing human, technologic, and organizational capacities, and develop metrics for individual project and overall initiative success. In Aim 2, we will assess the intersection of cancer care with AI and climate change with two research projects that will generate preliminary data for future projects while acting as a pilot process initiative for strategic and operating plan development. The first pilot will characterize oncologist perceptions of the ethical implications of AI for cancer care delivery in a cross-sectional national survey of practicing oncologists (N=684) that will assess familiarity with and prior training in AI as well as views on benefits, potential for bias, associated risks, related professional responsibilities, and impact on oncology practice. The second pilot will evaluate environmental and equity implications of tele-oncology. Using data from 1.25 million DF/HCC patient visits, we will characterize factors associated with access to tele-oncology and potential mortality benefits associated with emissions reduction during policy scenarios with differing levels of tele-oncology use. Completion of the proposed work will result in a research initiative strategically focused on major emerging bioethics issues that oncology patients, clinicians, and research scientists face. Moreover, the preliminary data generated by the two ...