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 rela tional nature of choice behaviour. The purpose of this paper is to explore an embedded decisional model of stress and coping that locates key assumpti ons of Janis & Mann's (1977) conflict-theory model of decision making withi n Lazarus & Folkman's (1984) transactional framework. Through combining dec isional and stress and coping theories, a model is developed that addresses the theoretical limitations of the conflict-theory model and provides grea ter specificity within decision-making research. The paper examines the com plexity of treatment decision making within the context of the constructs o f causal antecedents, primary appraisal, secondary appraisal, coping, and a daptational outcomes. Examples specific to women with breast cancer are pro vided to illustrate the potential application of the embedded model. The im plications of this inclusive and comprehensive decisional theory for future knowledge development and research in the area of treatment decision makin g are also discussed.