‘I’m being forced to make decisions I have never had to make before’: Oncologists and the conundrums created by COVID-19.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 12001-12001
Author(s):  
Chithra R. Perumalswami ◽  
Emily Chen ◽  
Carly Martin ◽  
Susan Dorr Goold ◽  
Raymond G. De Vries ◽  
...  
Keyword(s):  
Decision Making ◽  
Ethical Dilemmas ◽  
Resource Scarcity ◽  
Optimal Decision ◽  
Individual Interviews ◽  
Integrating Technology ◽  
Qualitative Data Analysis Software ◽  
Technology And Communication ◽  
Optimal Decision Making ◽  
Seriously Ill

12001 Background: The COVID-19 pandemic has created conundrums for physicians. This study examines the experiences of oncologists who engage in complex decision-making regarding the use of chemotherapy in seriously ill persons in the context of the COVID-19 pandemic. Methods: Between January 2020 and August 2020, the authors conducted semi-structured, in-depth individual interviews with 22 purposefully sampled oncologists from practices enrolled in the Michigan Oncology Quality Consortium. Transcripts were double-coded and reconciled by consensus using qualitative data analysis software for thematic analysis. Results: Among the thematic clusters we identified, one was related to conundrums created by the COVID-19 pandemic. In this presentation, we report the results pertaining to three themes within this cluster: (1) the ethical dilemmas faced by oncologists due to the COVID-19 pandemic, (2) the need for both patients and oncologists to manage uncertainty and emotions, and (3) the importance and complexity of integrating technology and communication for seriously ill persons. Oncologists grappled with several conundrums including resource scarcity, resource allocation, delays in care, a duty to promote equity and non-abandonment, high levels of uncertainty and fear, and the importance of advanced care directives and end-of-life care planning. Non-abandonment featured as a coping mechanism for increased stress, and integration of communication with telemedicine was frequent and necessary. Conclusions: This study offers an in-depth exploration of the conundrums faced by oncologists due to the COVID-19 pandemic and how they navigated them. Optimal decision-making for seriously ill persons with cancer during the COVID-19 pandemic must include open acknowledgement of the ethical dilemmas faced, the heightened emotions experienced by both patients and their oncologists, and the urgent need for integrating technology with compassionate communication in determining patient preferences.

scholarly journals “I'm Being Forced to Make Decisions I Have Never Had to Make Before”: Oncologists' Experiences of Caring for Seriously Ill Persons With Poor Prognoses and the Dilemmas Created by COVID-19

2021 ◽  
pp. OP.21.00119
Author(s):  
Chithra R. Perumalswami ◽  
Emily Chen ◽  
Carly Martin ◽  
Susan D. Goold ◽  
Raymond De Vries ◽  
...  
Keyword(s):  
Resource Scarcity ◽  
Optimal Decision ◽  
Ethical Challenges ◽  
Individual Interviews ◽  
Advance Care ◽  
Integrate Technology ◽  
Technology And Communication ◽  
Optimal Decision Making ◽  
Compassionate Communication ◽  
Seriously Ill

PURPOSE: The COVID-19 pandemic has created a new set of problems for clinicians. This study examines the experiences of oncologists providing care to seriously ill persons near the end of life in the context of the COVID-19 pandemic. METHODS: Between January 2020 and August 2020, we conducted semistructured, in-depth individual interviews with 22 purposefully sampled oncologists from practices enrolled in the Michigan Oncology Quality Consortium. Deidentified transcripts of the interviews were examined using thematic analysis. RESULTS: Our respondents described several novel problems created by the COVID-19 pandemic, including: (1) ethical challenges, (2) the need to manage uncertainty—physically and emotionally—on the part of both patients and oncologists, and (3) the difficulty of integrating technology and communication for seriously ill persons. These problems were made more complex by features of the pandemic: resource scarcity (and the need to fairly allocate poor resources), delays in care, high levels of fear, and the increased importance of advance care planning. Nonabandonment served as a way to cope with increased stress, and the use of telemedicine became an increasingly important medium of communication. CONCLUSION: This study offers an in-depth exploration of the problems faced by oncologists as a result of the COVID-19 pandemic and how they navigated them. Optimal decision making for seriously ill persons with cancer during the COVID-19 pandemic must include open acknowledgment of the ethical challenges involved, the emotions experienced by both patients and their oncologists, and the urgent need to integrate technology with compassionate communication in determining patient preferences.

scholarly journals GEAR: On Optimal Decision Making with Auxiliary Data

Stat ◽  
2021 ◽  
Author(s):  
Hengrui Cai ◽  
Rui Song ◽  
Wenbin Lu
Keyword(s):  
Decision Making ◽  
Optimal Decision ◽  
Auxiliary Data ◽  
Optimal Decision Making

Operation decision of logistics service supply chain: considering interruption probability in emergencies

Kybernetes ◽  
2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Guangsheng Zhang ◽  
Xiao Wang ◽  
Zhiqing Meng ◽  
Qirui Zhang ◽  
Kexin Wu
Keyword(s):  
Decision Making ◽  
Supply Chain ◽  
Evolutionary Game ◽  
Optimal Strategies ◽  
Optimal Decision ◽  
Content Type ◽  
Logistics Service ◽  
Social Reputation ◽  
Punishment Intensity ◽  
Optimal Decision Making

PurposeTo remedy the inherent defect in current research that focuses only on a single type of participants, this paper endeavors to look into the situation as an evolutionary game between a representative Logistics Service Integrator (LSI) and a representative Functional Logistics Service Provider (FLSP) in an environment with sudden crisis and tries to analyze how LSI supervises FLSP's operations and how FLSP responds in a recurrent pattern with different interruption probabilities.Design/methodology/approachRegarding the risks of supply chain interruption in emergencies, this paper develops a two-level model of single LSI and single FLSP, using Evolutionary Game theory to analyze their optimal decision-making, as well as their strategic behaviors on different risk levels regarding the interruption probability to achieve the optimal return with bounded rationality.FindingsThe results show that on a low-risk level, if LSI increases the degree of punishment, it will fail to enhance FLSP's operational activeness in the long term; when the risk rises to an intermediate level, a circular game occurs between LSI and FLSP; and on a high level of risk, FLSP will actively take actions, and its functional probability further impacts LSI's strategic choices. Finally, this paper analyzes the moderating impact of punishment intensity and social reputation loss on the evolutionary model in emergencies and provides relevant managerial implications.Originality/valueFirst, by taking both interruption probability and emergencies into consideration, this paper explores the interactions among the factors relevant to LSI's and FLSP's optimal decision-making. Second, this paper analyzes the optimal evolutionary game strategies of LSI and FLSP with different interruption probability and the range of their optimal strategies. Third, the findings of this paper provide valuable implications for relevant practices, such that the punishment intensity and social reputation loss determine the optimal strategies of LSI and FLSP, and thus it is an effective vehicle for LSSC system administrator to achieve the maximum efficiency of the system.

Blockchain Based Optimal Decision Making Of Dispatchable Units In Smart Grids Considering The High Uncertainty Effects

2021 ◽  
pp. 103418
Author(s):  
Xiangqian Zhu ◽  
Wenfeng Wang ◽  
Suhong Pang ◽  
Chaoyin An ◽  
Xiaoliang Yang ◽  
...  
Keyword(s):  
Decision Making ◽  
Smart Grids ◽  
Optimal Decision ◽  
Optimal Decision Making ◽  
High Uncertainty
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