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

•Triage nurses use a decision support tool during telephone triage.•The display of this tool encourages triage nurses to use either/or-questions.•Either/or-questions can lead to interactional difficulties during telephone triage.•Conversation analysis shows two problematic categories either/or-questions.•More awareness is needed on ineffective consequences of either/or-questions. 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. 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. 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”). 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. 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.