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 Carmen; Charldorp, T.C. van; Vinck, Vera; Wouters, Loes; Damoiseaux, Roger; Rutten, Frans H.; Zwart, Dorien; Groot, Esther de

doi:10.1016/j.pec.2020.07.011

Cited by 14 publications

(10 citation statements)

References 27 publications

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“…Furthermore, interviews with triage nurses revealed that the NTS may hinder triage, especially in very urgent calls where emotions of both triage nurses and patients are prominent during the telephone conversation 15. Previous studies from our research group showed that the accuracy of NTS was at the best moderate for patients with chest discomfort or suspected neurological deficits, and that both the NTS itself as working with the tool could be improved in these important domains 11 12 15 16. Thus, it is important to analyse the use of the NTS by triage nurses as well beside the NTS itself.…”

Section: Introductionmentioning

confidence: 99%

Optimising telephone triage of patients calling for acute shortness of breath during out-of-hours primary care: protocol of a multiple methods study (Opticall)

et al. 2022

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IntroductionCallers with acute shortness of breath (SOB) are a challenge for telephone triage at out-of-hours primary care (OHS-PC) as SOB could be the sign of a potentially life-threatening disease, yet mostly is a symptom of a broad range of self-limiting disorders. Current telephone triage practice is mainly expert based and clear evidence on accuracy, safety and efficiency of the use of the Netherlands Triage Standard (NTS) by triage nurses based on the eventual clinical outcome is lacking for this domain.Methods and data analysisMultiple methods study in five OHS-PC services in the Utrecht region, the Netherlands. Data will be collected from OHS-PC electronic health records (EHR) and backed up tapes of telephone triage conversations, which will be linked to routine primary care EHR data. In cross-sectional studies, we will (1) validate the NTS urgency classification for adults with SOB against final diagnoses and (2) develop diagnostic prediction models for urgent diagnoses (eg, composite endpoint of urgent diagnoses, pulmonary embolism, acute coronary syndrome, acute heart failure and pneumonia). We will develop improvement measures for the use of the NTS by triage nurses through practice observations and semistructured interviews with patients, triage nurses and general practitioners (GPs). In an action research approach, we will, in collaboration with these stakeholders, implement and evaluate our findings in both GP and triage nurse educational programmes as well as in OHS-PC services.Ethics and disseminationThe Medical Ethics Review Committee Utrecht, the Netherlands, approved the study protocol (protocol 21/361). We will take into account the ‘code of conduct for responsible research’ of the WHO, the EU General Data Protection Regulation and the ‘Dutch Medical Treatment Contracts Act’. Results will be disseminated in peer-reviewed publications and at (inter)national meetings.Trial registration numberNL9682.

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Section: Introductionmentioning

confidence: 99%

Optimising telephone triage of patients calling for acute shortness of breath during out-of-hours primary care: protocol of a multiple methods study (Opticall)

et al. 2022

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“…Reaching mutual understanding of symptoms was challenging, and the lack of a suitable, and shared, vocabulary was sometimes evident in Study IV. Conversations illustrated the role of telenurses as interpreters or translators of data between healthcare organisations and callers, as described by Greenberg (2009), but also illustrates the crucial role of callers in verbalising the problem in a constructive way (Erkelens et al, 2021;Holmström et al, 2021;Yliluoma & Palonen, 2020). If callers lack vocabulary, the telenurse must be able to suggest descriptions that are recognisable and intelligible for all callers.…”

Section: Satisfaction With Components Of Interactionmentioning

confidence: 97%

“…Using conversation analysis as analytic method in future research may elucidate good and/or bad strategies for the development of interaction on health information. Examples of such studies are Lopriore et al (2019), who found that contrasting present health status with normal health was a frequent and mostly successful way to examine symptoms without visual cues, while Erkelens et al (2021) identified that using either-/or formulated questions led to difficulties in verbal physical examinations. The challenge of providing clear advice has previously been described (Gamst-Jensen et al, 2017) but knowing that advice should be provided in a clear manner does not specify how this could be done.…”

Section: Satisfaction With Components Of Interactionmentioning

confidence: 99%

"I'm calling for hope, comfort and maybe some advice..." : Interaction and caller satisfaction in telenursing

Mattisson

2023

Linköping University Medical Dissertations

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Background:The provision of nursing over the telephone is an appreciated asset in many parts of the world. Interaction between telenurse and caller is important for caller satisfaction, and satisfaction in turn is positively related to outcomes such as adherence, engagement in self-care and well-being. Despite the long history of telehealth services, research about interaction in telenursing is still in a developmental stage. Aim:The overall aim of the thesis was to develop a questionnaire that enables valid and reliable exploration of telenurse-caller interaction, and caller satisfaction with calls, and to explore interaction and its importance for caller satisfaction.In addition, data was coded and analysed in relation to phases in the conversation process for telenursing: opening, listening, analysing, motivating, and ending. Results:The 60 item TISQ, including the TISS, showed good content validity in the telenursing setting with a Scale-CVI of 0.91 (I). Test-retest reliability of single items was moderate to good (I). TISS-data deviated significantly from a normal distribution, but all response options were endorsed (II). The confirmatory factor analysis confirmed the four-factor structure of the TISS, and factor correlations were high (rs = 0.88 to 0.96) (II). A higher order model showed marginally deteriorated model fit values (II). Ordinal alpha, scale reliability, and test-retest reliability were satisfactory for all scales, and convergent validity was satisfactory (II).Callers expressed the highest level of satisfaction with affective support, while their satisfaction with decisional control was comparatively lower (III). Callers' satisfaction with interaction was positively associated with overall satisfaction with calls, even when considering experienced waiting time, main result of the call, fulfilment of expectations, age, gender, selfrated health status and time of call (III). A total of 97% of manifest words in conversations were identified as nursing interaction based on the IM-CHB (IV). Health information was the primary focus, particularly during the listening and analysing phases (IV). Affective support was the least prominent component, and callers' reactions to advice were seldom discussed (IV). The opening phase was the shortest, and analysing phase the most word consuming (IV). Conclusions:The TISQ, including the TISS, provide a valid and reliable questionnaire for the study of telenurse-caller interaction, and caller satisfaction with calls. Caller satisfaction with the interaction can be measured using the four subscales in the TISS. In cases where there is a problem with multicollinearity, a total scale score from the TISS can be utilized. All four components of interaction in the IMCHB play a crucial role in determining overall caller satisfaction with calls. Therefore, the development of interaction in telenursing need to consider all four components. The exchange of health information presents challenges for both telenurses and callers, and affective support can be provided to caller...

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“…Deppermann and Spraz-Fogasy's (2011, p. 115) observations of history-taking in German doctor-patient interactions lead them to conclude that the contrast between open-ended and closed questions is "ideologically overrated" and does not take into account "the patients' power to negotiate what was made relevant by a question and their capacity to resist narrow expectations". Indeed, patients can highlight the insufficiency of the question formulation, problematisingfor examplethe restricted response options or presuppositions of a questioning utterance, as demonstrated by Erkelens et al (2021). Ultimately, a 'closed' question does not necessarily entail a minimal response and using an 'open' question does not guarantee that the respondent will say more.…”

Section: 'Doing Questioning'mentioning

confidence: 99%

’Doing Questioning’ in the Emergency Department (ED)

Collins

Gablasová

Pill

2022

Health Communication

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Eliciting information from patients is fundamental to medical professionals' capacity to deliver good healthcare outcomes in Emergency Departments (EDs).There are different kinds of utterances that 'do questioning' (Ehrlich & Freed, 2009, p. 6), and health professionals can variously attend to the medical agenda and the interpersonal aspects of their interactions with those attending the ED in the way that they construct these utterances. We investigate a corpus of ED interactions to determine the prevalence and range of utterances produced by doctors and directed at patients that 'do questioning'. We developed a questioning utterance typology, informed by previous research on the formulation of such utterances and extended according to observations of our data. We subsequently manually coded 4,355 questioning utterances and report the variety of forms that such utterances can take, considering how these are distributed across doctors at different levels of seniority. We found that doctors at different seniority levels favoured similar questioning utterance types and the most frequently used appeared to restrict the contributions of patients. We conclude that our extended typology of questioning utterances has value for understanding the ways in which doctors may encourage patients to provide more extensive responses.

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

Cited by 14 publications

References 27 publications

Optimising telephone triage of patients calling for acute shortness of breath during out-of-hours primary care: protocol of a multiple methods study (Opticall)

Optimising telephone triage of patients calling for acute shortness of breath during out-of-hours primary care: protocol of a multiple methods study (Opticall)

"I'm calling for hope, comfort and maybe some advice..." : Interaction and caller satisfaction in telenursing

’Doing Questioning’ in the Emergency Department (ED)

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