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

C.A.M. Erkelens; Tessa Cyrina Charldorp; Vera Vinck; Loes Wouters; Roger Damoiseaux; Frans Rutten; Dorien 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

C.A.M. Erkelens
, Tessa Cyrina Charldorp
, Vera Vinck
, Loes Wouters
, Roger Damoiseaux
, Frans Rutten
, Dorien Zwart
, Esther de Groot

ILS - Language and communication

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

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

Bibliographical 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 ‘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)

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

Cite this

Erkelens, C. A. M., Charldorp, T. C., Vinck, V., Wouters, L., Damoiseaux, R., Rutten, F., Zwart, D., & 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{e73a25ebab7846138a87ec8b82ef796a,

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 {\textquoteleft}Netherlands Triage Standard{\textquoteright} (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{\textquoteright} 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{\textquoteright}s complaints are ambiguously presented reflecting patient{\textquoteright}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 = "C.A.M. Erkelens and Charldorp, \{Tessa Cyrina\} and Vera Vinck and Loes Wouters and Roger Damoiseaux and Frans Rutten and Dorien Zwart 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",

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Erkelens, CAM, Charldorp, TC, Vinck, V, Wouters, L, Damoiseaux, R, Rutten, F, Zwart, D & 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, C.A.M.; Charldorp, Tessa Cyrina; Vinck, Vera 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: A conversation analysis

AU - Erkelens, C.A.M.

AU - Charldorp, Tessa Cyrina

AU - Vinck, Vera

AU - Wouters, Loes

AU - Damoiseaux, Roger

AU - Rutten, Frans

AU - Zwart, Dorien

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

UR - https://www.scopus.com/pages/publications/85088102902

U2 - 10.1016/j.pec.2020.07.011

DO - 10.1016/j.pec.2020.07.011

M3 - Article

SN - 0738-3991

VL - 104

SP - 308

EP - 314

JO - Patient Education and Counseling

JF - Patient Education and Counseling

IS - 2

ER -

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

Abstract

Bibliographical note

Keywords

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