PhD defense of Clémence BRUN from TIMC's ThEMAS team on Monday, November 6, 2023, at 2pm:

"Impact of intolerance of uncertainty on health care decision-making."

Jury

• Nicolas PINSAULT, Professeur des Universités, Université Grenoble Alpes, Supervisor
• Richard MONVOISIN, Ingénieur de Recherche, enseignant à l'Université Grenoble Alpes, Co-Supervisor
• Oulmann ZERHOUNI, Professeur des Universités, Université de Rouen Normandie, Co-Supervisor
• Lucia ROMO, Professeure des Universités, Université Paris 10 - Nanterre, Reporter
• Armand CHATARD Professeur des Universités, Université de Poitiers, Reporter
• Aurélie GAUCHET, Professeure des Universités, Université de Chambéry, Examiner
• Jacques VAILLANT, Docteur en Sciences, HDR, Université Grenoble Alpes, Examiner
• Jean-Luc BOSSON, Professeur des Universités – Praticien Hospitalier, Université Grenoble Alpes, Examiner

Supervision

• Nicolas PINSAULT, Professeur des Universités, Université Grenoble Alpes, Supervisor
• Richard MONVOISIN, Ingénieur de Recherche, enseignant à l'Université Grenoble Alpes, Co-Supervisor
• Oulmann ZERHOUNI, Professeur des Universités, Université de Rouen Normandie, Co-Supervisor

  Keywords

Intolerance of uncertainty, Clinical reasoning, Critical thinking, Health decisions, Decision-making

  Abstract

Critical thinking is considered a set of essential skills and dispositions, given that its mastery can influence our decisions and behaviors significantly. Discussed for almost 40 years, critical thinking has underwent a more advanced didactic formalization in the past decade and has become the subject of various studies, tests, and psychometric scales. The purpose of this thesis was twofold: 1) to study the exercise of critical thinking and analyze its underlying decision-making processes in a major area of interest: reasoning in the context of health decision-making, and 2) to specifically evaluate the influence of intolerance of uncertainty, a variable that seems to have negative effects on reasoning. We first conducted a systematic literature review on the relationships between intolerance of uncertainty and clinical reasoning. This initial study led us to conclude that the influence of intolerance of uncertainty on clinical reasoning is underexplored and that the main studies on this topic demonstrate significant effects on the investigative and prescribing behaviors of healthcare professionals. However, we lacked measurement tools psychometrically validated in the French language to conduct experiments directly assessing the influence of this variable on health-related reasoning. For this reason, in a second study, we carried out psychometric validation of two French scales measuring intolerance of uncertainty (IUS-12, a general scale developed for the general population, and IUS-12-H, developed specifically for healthcare professionals). Our analyses confirmed good psychometric qualities, allowing us to directly investigate the influence of intolerance of uncertainty on health decisions in both the general population and healthcare professionals. In the third study of this thesis, we showed to individuals from the general population fictional pandemic situations to study their vaccination behaviors. Our analyses revealed that intolerance of uncertainty and attitudes toward vaccination impact vaccination decisions, while perceived uncertainty in the situation does not. Following this study, we shifted our focus to healthcare professionals. In a fourth study, we asked physiotherapists to play a serious game simulating clinical cases of increasing difficulty to study the influence of their level of intolerance of uncertainty and resource consumption (e.g., tests results) on the therapeutic strategy they proposed to their patients. These two variables influenced the strategies proposed by physiotherapists only for the easy clinical case. We formulated several hypotheses regarding these results. To conclude this thesis, we discuss future research perspectives for both typologies of actors in the context of health decision-making: healthcare professionals and patients, and we provide general implications for the field of critical thinking.