In the treatment of cancer, doctors in resource-constrained settings are routinely required to make high-stake decisions under uncertain conditions along with rising burden of cancer, substantial patient load on doctors, and poor healthcare infrastructure that further complicate the decision process. However, very few studies examine the real-world decision process given the prevalence of such factors. Using the naturalistic decision-making framework, this study aimed to understand the critical decisions that doctors face in the treatment of cancer and how they take such decisions. Twenty-five doctors working in a government hospital in India were interviewed, and the data was subjected to thematic analysis. Three central concepts were identified: communicating the illness, different shades of paternalism during the treatment process, and the complexity of the decision process. The critical decisions that doctors faced were found to be treatment-related decisions, resource constraint decisions, and difficulties in communicating the illness. The study provides deep insights into how the doctors ‘tailor’ the decisions according to the unique contextual realities of individual patients. It further elucidates the intersecting nature of these contextual factors and how they influence the decision process. The study makes significant theoretical and practical implications, such as designing support systems and training programs that enhance decision-making in cancer care within resource-limited healthcare settings.