An embedded decisional model of stress and coping: implications for exploring treatment decision making by women with breast cancer

Treatment decision making by women with breast cancer has been recognized t o be an inherently stressful process. However, past decisional theory and r esearch has failed to fully elucidate the personal, transactional and relat ional nature of choice behaviour. The purpose of this paper is to explore a n embedded decisional model of stress and coping that locates key assumptio ns of Janis and Mann's conflict-theory model (CTM) of decision making withi n Lazarus and Folkman's transactional framework. Through combining decision al and stress and coping theories, a model is developed that addresses the theoretical limitations of the CTM and provides greater specificity within decision-making research. The paper examines the complexity of treatment de cision making within the context of the constructs of causal antecedents, p rimary appraisal, secondary appraisal, coping and adaptational outcomes. Ex amples specific to women with breast cancer are provided to illustrate the potential application of the embedded model. The implications of this inclu sive and comprehensive decisional theory for future knowledge development a nd research in the area of treatment decision making are also discussed.