| The contemporary management of early breast cancer poses a significant decision problem for physicians, who must evaluate controversial and substantively different treatment options for initial local treatment and adjuvant systemic therapy, and determine how they will care for women. It is acknowledged that the ultimate choice of treatment is the woman's. The focus of this study, however, was on the physician component of the decision making process.;The purpose of this descriptive study was to enhance understanding of how physicians determine treatment for women with early breast cancer, to expand the knowledge base available to professionals who care for women with breast cancer. Particular emphasis was placed on the decision related to initial surgical treatment. Factors considered by physicians in determining treatment were explored in focused, in-depth, audiotaped interviews with 33 physicians actively involved in caring for women with breast cancer. In addition, comments related to the treatment of women with early breast cancer, obtained from 11 other physicians interviewed by the investigator in a separate study, were admitted for secondary analysis.;The method of analytic induction was used to analyze the verbatim interview data. Clinical and socio-personal factors considered in the treatment decision were identified. A theoretical framework was proposed to explain the process of decision making, in light of the complexity and uncertainty in the decision and the variability in how physicians regarded the factors.;It is proposed that three domains of physician reality inform the treatment decision, that is, are accessed by the physician in the determination of treatment. These are the domains of formal knowledge, clinical practice, and consideration of woman as person. The domains function as perspectives from which to consider treatment for an individual woman. Components within the domains and processes by which uncertainty in the decision is managed are described. The fundamental principle that undergirds the decision is the dictum "Do no harm". It is from this stand that the physician evaluates information available in the domains of formal knowledge and clinical practice, as well as considers the meaning, impact, and consequences of the experience, including the treatment chosen, for the individual woman. |
