Interactional implications of either/or-questions during telephone triage of callers with chest discomfort in out-of-hours primary care: A conversation analysis

Daphne C Erkelens; Tessa C van Charldorp; Vera V Vinck; Loes T Wouters; Roger A Damoiseaux; Frans H Rutten; Dorien L Zwart; Esther de Groot

doi:10.1016/j.pec.2020.07.011

Interactional implications of either/or-questions during telephone triage of callers with chest discomfort in out-of-hours primary care: A conversation analysis

Daphne C Erkelens, Tessa C van Charldorp, Vera V Vinck, Loes T Wouters, Roger A Damoiseaux, Frans H Rutten, Dorien L Zwart, Esther de Groot

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

OBJECTIVE: To explore the interactional implications of either/or-questions on the interaction between people who call out-of-hours services in primary care (OHS-PC) and triage nurses who use a decision support tool called the 'Netherlands Triage Standard' (NTS) during telephone triage.

METHODS: A qualitative study of 68 triage conversations at six Dutch OHS-PC. Patients called the OHS-PC with symptoms, e.g. chest discomfort, suggestive of acute coronary syndrome. Using conversation analysis, we identified two categories of multiple-choice either/or-questions that indicated interactional difficulties, shown in hesitation markers within callers' responses.

RESULTS: Our analysis shows that interactional difficulties mainly arise when (i) questions are poorly designed by the triage nurse; or (ii) when the caller's complaints are ambiguously presented reflecting patient's difficulties to verbalize them (e.g. "not feeling well").

CONCLUSION: The way NTS displays key diagnostic options encourages triage nurses to use multiple-choice either/or-questions. More awareness among triage nurses is needed on undesirable implications of either/or-questions on the interaction.

PRACTICE IMPLICATIONS: We recommend changing the NTS display of diagnostic options and to use questions with fewer options in order to decrease the chance of formulating ambiguous questions soliciting unclear responses. Furthermore, asking content questions when complaints are ambiguously formulated may specify the presentation of complaints.

Original language	English
Pages (from-to)	308-314
Number of pages	7
Journal	Patient Education and Counseling
Volume	104
Issue number	2
DOIs	https://doi.org/10.1016/j.pec.2020.07.011
Publication status	Published - Feb 2021

Keywords

Chest discomfort
Communication
Conversation analysis
Multiple-choice either/or-questions
Out-of-hours primary care
Telehealth
Telephone triage

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1-s2.0-S0738399120303840-mainFinal published version, 1.1 MBLicence: CC BY

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Erkelens, D. C., van Charldorp, T. C., Vinck, V. V., Wouters, L. T., Damoiseaux, R. A., Rutten, F. H., Zwart, D. L., & de Groot, E. (2021). Interactional implications of either/or-questions during telephone triage of callers with chest discomfort in out-of-hours primary care: A conversation analysis. Patient Education and Counseling, 104(2), 308-314. https://doi.org/10.1016/j.pec.2020.07.011

@article{40b9a08386bd4bf392c5f64eb160a29f,

title = "Interactional implications of either/or-questions during telephone triage of callers with chest discomfort in out-of-hours primary care: A conversation analysis",

abstract = "OBJECTIVE: To explore the interactional implications of either/or-questions on the interaction between people who call out-of-hours services in primary care (OHS-PC) and triage nurses who use a decision support tool called the 'Netherlands Triage Standard' (NTS) during telephone triage.METHODS: A qualitative study of 68 triage conversations at six Dutch OHS-PC. Patients called the OHS-PC with symptoms, e.g. chest discomfort, suggestive of acute coronary syndrome. Using conversation analysis, we identified two categories of multiple-choice either/or-questions that indicated interactional difficulties, shown in hesitation markers within callers' responses.RESULTS: Our analysis shows that interactional difficulties mainly arise when (i) questions are poorly designed by the triage nurse; or (ii) when the caller's complaints are ambiguously presented reflecting patient's difficulties to verbalize them (e.g. {"}not feeling well{"}).CONCLUSION: The way NTS displays key diagnostic options encourages triage nurses to use multiple-choice either/or-questions. More awareness among triage nurses is needed on undesirable implications of either/or-questions on the interaction.PRACTICE IMPLICATIONS: We recommend changing the NTS display of diagnostic options and to use questions with fewer options in order to decrease the chance of formulating ambiguous questions soliciting unclear responses. Furthermore, asking content questions when complaints are ambiguously formulated may specify the presentation of complaints.",

keywords = "Chest discomfort, Communication, Conversation analysis, Multiple-choice either/or-questions, Out-of-hours primary care, Telehealth, Telephone triage",

author = "Erkelens, {Daphne C} and {van Charldorp}, {Tessa C} and Vinck, {Vera V} and Wouters, {Loes T} and Damoiseaux, {Roger A} and Rutten, {Frans H} and Zwart, {Dorien L} and {de Groot}, Esther",

note = "Funding Information: This work was supported by the department of general practice of the University Medical Center Utrecht , Associate Professorship-promotion grant of D.L. Zwart, MD, PhD, the foundation {\textquoteleft}Netherlands Triage Standard{\textquoteright} and the foundation {\textquoteleft}Stoffels-Hornstra{\textquoteright}. The views expressed are those of the authors and not necessarily those of the foundations. The funding foundations had no role in study design, data collection and analysis, preparation of the article, or decision to publish. Publisher Copyright: {\textcopyright} 2020 The Author(s)",

year = "2021",

month = feb,

doi = "10.1016/j.pec.2020.07.011",

language = "English",

volume = "104",

pages = "308--314",

journal = "Patient Education and Counseling",

issn = "0738-3991",

publisher = "Elsevier Ireland Ltd",

number = "2",

}

Erkelens, DC, van Charldorp, TC, Vinck, VV, Wouters, LT, Damoiseaux, RA , Rutten, FH , Zwart, DL & de Groot, E 2021, 'Interactional implications of either/or-questions during telephone triage of callers with chest discomfort in out-of-hours primary care: A conversation analysis', Patient Education and Counseling, vol. 104, no. 2, pp. 308-314. https://doi.org/10.1016/j.pec.2020.07.011

Interactional implications of either/or-questions during telephone triage of callers with chest discomfort in out-of-hours primary care: A conversation analysis. / Erkelens, Daphne C; van Charldorp, Tessa C; Vinck, Vera V et al.
In: Patient Education and Counseling, Vol. 104, No. 2, 02.2021, p. 308-314.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Interactional implications of either/or-questions during telephone triage of callers with chest discomfort in out-of-hours primary care

T2 - A conversation analysis

AU - Erkelens, Daphne C

AU - van Charldorp, Tessa C

AU - Vinck, Vera V

AU - Wouters, Loes T

AU - Damoiseaux, Roger A

AU - Rutten, Frans H

AU - Zwart, Dorien L

AU - de Groot, Esther

N1 - Funding Information: This work was supported by the department of general practice of the University Medical Center Utrecht , Associate Professorship-promotion grant of D.L. Zwart, MD, PhD, the foundation ‘Netherlands Triage Standard’ and the foundation ‘Stoffels-Hornstra’. The views expressed are those of the authors and not necessarily those of the foundations. The funding foundations had no role in study design, data collection and analysis, preparation of the article, or decision to publish. Publisher Copyright: © 2020 The Author(s)

PY - 2021/2

Y1 - 2021/2

N2 - OBJECTIVE: To explore the interactional implications of either/or-questions on the interaction between people who call out-of-hours services in primary care (OHS-PC) and triage nurses who use a decision support tool called the 'Netherlands Triage Standard' (NTS) during telephone triage.METHODS: A qualitative study of 68 triage conversations at six Dutch OHS-PC. Patients called the OHS-PC with symptoms, e.g. chest discomfort, suggestive of acute coronary syndrome. Using conversation analysis, we identified two categories of multiple-choice either/or-questions that indicated interactional difficulties, shown in hesitation markers within callers' responses.RESULTS: Our analysis shows that interactional difficulties mainly arise when (i) questions are poorly designed by the triage nurse; or (ii) when the caller's complaints are ambiguously presented reflecting patient's difficulties to verbalize them (e.g. "not feeling well").CONCLUSION: The way NTS displays key diagnostic options encourages triage nurses to use multiple-choice either/or-questions. More awareness among triage nurses is needed on undesirable implications of either/or-questions on the interaction.PRACTICE IMPLICATIONS: We recommend changing the NTS display of diagnostic options and to use questions with fewer options in order to decrease the chance of formulating ambiguous questions soliciting unclear responses. Furthermore, asking content questions when complaints are ambiguously formulated may specify the presentation of complaints.

AB - OBJECTIVE: To explore the interactional implications of either/or-questions on the interaction between people who call out-of-hours services in primary care (OHS-PC) and triage nurses who use a decision support tool called the 'Netherlands Triage Standard' (NTS) during telephone triage.METHODS: A qualitative study of 68 triage conversations at six Dutch OHS-PC. Patients called the OHS-PC with symptoms, e.g. chest discomfort, suggestive of acute coronary syndrome. Using conversation analysis, we identified two categories of multiple-choice either/or-questions that indicated interactional difficulties, shown in hesitation markers within callers' responses.RESULTS: Our analysis shows that interactional difficulties mainly arise when (i) questions are poorly designed by the triage nurse; or (ii) when the caller's complaints are ambiguously presented reflecting patient's difficulties to verbalize them (e.g. "not feeling well").CONCLUSION: The way NTS displays key diagnostic options encourages triage nurses to use multiple-choice either/or-questions. More awareness among triage nurses is needed on undesirable implications of either/or-questions on the interaction.PRACTICE IMPLICATIONS: We recommend changing the NTS display of diagnostic options and to use questions with fewer options in order to decrease the chance of formulating ambiguous questions soliciting unclear responses. Furthermore, asking content questions when complaints are ambiguously formulated may specify the presentation of complaints.

KW - Chest discomfort

KW - Communication

KW - Conversation analysis

KW - Multiple-choice either/or-questions

KW - Out-of-hours primary care

KW - Telehealth

KW - Telephone triage

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DO - 10.1016/j.pec.2020.07.011

M3 - Article

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SN - 0738-3991

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JO - Patient Education and Counseling

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ER -

Interactional implications of either/or-questions during telephone triage of callers with chest discomfort in out-of-hours primary care: A conversation analysis

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