Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal.

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal.

L'annonce d'une mauvaise nouvelle en cancérologie constitue un exercice anxiogène pour les médecins. La théorie de la régulation émotionnelle laisse à penser que les médecins vont avoir recours à des stratégies afin de réguler leurs émotions au moment de l'annonce. Nous nous sommes interrogés sur l'impact des stratégies de régulation émotionnelle des médecins confrontés à l'annonce d'une mauvaise nouvelle, sur l'ajustement psychologique de leurs patients. Pour y répondre, quatre études ont été menées. La première visait à analyser l'anxiété des médecins et deux stratégies de régulation émotionnelles ( la réévaluation cognitive et la suppression expressive), à l'annonce d'une mauvaise nouvelle. Dans la seconde étude, les résultats de l'analyse quantitative d'entretiens menés auprès de médecins nous ont permis d'élargir l'éventail des émotions (négatives et positives) et des stratégies de régulation émotionnelle des médecins à l'annonce d'une mauvaise nouvelle. Dans la troisième étude, l'analyse IPA du discours des médecins a fait émerger deux éléments clés de compréhension de l'expérience subjective des médecins face à l'annonce : le sens que les médecins donnent à l'annonce et à leur rôle, et le lien établi avec leurs patients. La dernière étude s'est focalisée sur l'analyse des liens entre l'anxiété, les stratégies de régulation émotionnelle et les compétences relationnelles des médecins au moment de l'annonce, et l'ajustement psychologique de leurs patients quinze jours après l'annonce. Les résultats de ces quatre études apportent de nouveaux éléments de réflexion concernant les formations à l'annonce de mauvaises nouvelles proposées aux médecins. / Breaking bad news in oncology is a difficult task for physicians, generating anxiety. The theory of emotion regulation suggests that physicians are using emotion regulation strategies to influence their emotions when breaking bad news to patients. The literature has led us to question the impact of the emotion regulation strategies of physicians facing giving bad news in oncology, on their patient's psychological adjustment. To address this topic, four studies were carried out. The first one enables us to analyse physicians' anxiety and two emotions regulation strategies (expressive suppression and cognitive reappraisal) at three different stages of the announcement : just before, just after and a week later. In the second study, the results of qualitative analysis from semi-structured interviews with physicians allow us to expand the range of emotions (negative and positive) and physicians' emotion regulation strategies when announcing a bad news. In the third study, the interpretative phenomenological analysis of the physicians' interviews enables us to understand two key elements of the subjective experience of physicians facing the announcement : the importance that physicians give to the announcement and their role, and the relationship established with their patients. Tha last study focusses on the analysis of the link between anxiety, emotion regulation strategies and the physicians' interpersonal skills when breaking bad news in oncology, and the patient's psychological adjustment fifteen days after the announcement. The results of these four studies allow to provide new lines of approach regarding the training in breaking bad news currently available for physicians.

Grounded in the Positive Youth Development (PYD) approach and in Bronfenbrenner’s ecological model of human development (1979), the current research program used a correlational approach to examine the effect of participation in organized activities (OAs) on two dimensions of youth’s psychological and emotional development: Psychological adjustment (Article 1) and Emotional competence (Article 2). Through two articles and four studies, this research program also aimed to explore the influence of two OA-context variables, youth experiences and youth engagement, on the previous dimensions of development. Together, results aimed to provide new information in the PYD research domain. Main findings are described. First, we hypothesized that participation in OAs had a positive effect on indicators of youth psychological and emotional development. Overall, our results indicated that this effect was not statistically significant (Article 1, Study 2; Article 2, Studies 1 and 2), although some statistically significant differences were found between OA participants’ and non-participants’ psychological adjustment in a correlational design (Article 1, Study 1). The potential implications of these results, as well as their limitations, are discussed. The current research also examined the potential role of youth experiences within their OAs in the link between OA participation and psychological and emotional development. Overall, results indicated that some experiences in OA contexts were statistically significant predictors of psychological adjustment and emotional competence. Furthermore, experiences of identity emerged as mediators of the effect of participation on life satisfaction in a longitudinal design (Article 1, Study 2). However, this effect was negative and may be best explained by the presence of a suppression effect in the model. Moreover, experiences of initiative and stress emerged as mediators of the effect of participation on emotional competence (Article 2, Study 1), but results were not replicated in a longitudinal design (Article 2, Study 2). This research also examined the potential role of youth’s engagement in their OAs on psychological and emotional development (Article 1, Study 2; Article 2, Study 2). The inclusion of engagement in our research program was crucial and allowed for the identification of specific necessary conditions for participation to have an effect on outcomes of psychological and emotional development. In our research, engagement emerged as a moderator of the indirect effects of participation on two indicators of psychological and emotional development. First, the indirect effect of participation on self-esteem through experiences of initiative emerged as statistically significant only for youth who were highly engaged in their OA (Article 1, Study 2). Next, the negative indirect effect of participation on life satisfaction through experiences of identity emerged as significant only for youth who were highly engaged in their OA. Again, the latter result might be best explained by the presence of a suppression effect (Article 1, Study 2). Lastly, engagement also emerged as a moderator of the effect of participation on specific youth experiences (Article 1, Study 2). Implications for theory and practice emerge from this research. A better understanding of the effect of OA participation on psychological and emotional development and of the specific roles of youth experiences and youth engagement in OAs is attained. Practical implications are discussed. In line with its exploratory nature, the current research program provides multiple avenues for future research within the PYD approach.

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