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

Abstract

Treatment decision making by women with breast cancer has been recognized to be an inherently stressful process. However, past decisional theory and research has failed to fully elucidate the personal, transactional and relational nature of choice behaviour. The purpose of this paper is to explore an embedded decisional model of stress and coping that locates key assumptions of Janis and Mann's conflict-theory model (CTM) of decision making within Lazarus and Folkman's transactional framework. Through combining decisional 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 decision making within the context of the constructs of causal antecedents, primary appraisal, secondary appraisal, coping and adaptational outcomes. Examples specific to women with breast cancer are provided to illustrate the potential application of the embedded model. The implications of this inclusive and comprehensive decisional theory for future knowledge development and research in the area of treatment decision making are also discussed.

Bridging the gap: decision-making processes of women with breast cancer using complementary and alternative medicine (CAM)

“…Similar to our study, stress has been found to be one of the defining features of cancer patients' treatment decisionmaking processes [4,14,16,23,35,36]. Beyond the distress caused by the cancer diagnosis, stress is also caused when patients take on decision-making roles they feel unprepared for, are faced with treatment options with similar outcomes, or have insufficient time to consider all treatment alternatives.…”

“…Beyond the distress caused by the cancer diagnosis, stress is also caused when patients take on decision-making roles they feel unprepared for, are faced with treatment options with similar outcomes, or have insufficient time to consider all treatment alternatives. Drawing on past conceptualizations of choice behavior, such as the Conflict-Theory Model [26] and the Transactional Model of Stress and Coping [27], the assumption has been made that decision making is an inherently stressful process that is characterized by risk, ambiguity, and conflict [4]. As such, it is imperative that collaborative decision support interventions be developed that help mitigate the distress felt by cancer patients attempting to reconcile different paradigms of care.…”

Dancing Around Infertility: The Use of Metaphors in a Complex Medical Situation

“…Because infertility consists of medical, emotional, psychological, and social complexities, many individuals in our study mentioned that they engaged in various coping styles, including emotion-focused (i.e., changing one's internal response to infertility) and problem-focused strategies (i.e., changing the behavior or environment in some way) (Balneaves & Long, 1999); however, coping with infertility stress remained a challenge and they did not know how to tell others what they needed in order to achieve well-being. The current study provides a framework that provides insight into how individuals understand their complex medical experience, why they may experience difficulty when talking to others about a taboo topic, and how they may improve communication to more effectively meet their needs for well-being.…”

Exploration of How Women Make Treatment Decisions After a Breast Cancer Diagnosis

“…According to Balneaves and Long (1999) quantitative measures assessing treatment decision making are severely lacking in the literature and it is unclear if social implications impact how women with breast cancer balance physical, psychosocial, and social issues when making medical treatment decisions. Additional research using prospective studies needs to be performed to assess the quality of information given to breast cancer patients about treatment options, how the information is assimilated, and analyze the effectiveness of interventions healthcare providers use to help women in decision making Finally, holds the opinion that the measurement of regret has not been consistently measured in health care and the concept is often left undefined or only measured by a single question.…”