/ Merseyside and Cheshire
Palliative Care Network Audit Group
Prevention of Pathological Fractures in Palliative Care /

Health Care Professionals Questionnaire

ICN:  Aintree Western Cheshire

 Warrington Isle of Man

 Liverpool Halton

 St Helens and Knowsley West Lancs., Southport & Formby  Wirral

SETTING: HospiceHospital Community

PROFESSION:Doctor If so, grade......

Clinical Nurse Specialist

1. / Approximately how many patients with bone pain or bone metastaseshave you advised referral/referred –for an orthopaedic opinion in the last 12 months?
……………………………………………………………………………………………………………………………………………………………………………………
2. / Approximately how many patients with bone pain or bone metastases have you advised referral/referred – for an oncological opinion in the last 12 months?
……………………………………………………………………………………………………………………………………………………………………………………
3. / What orthopaedic procedures to prevent pathologicalfracture have your patients received in the past 12 months?
Intramedullary nail
Cemented hemi arthroplasty
Total joint replacement
Plate fixation with cement augmentation
Endoprosthesis
No procedure
Procedures took place after pathological fracture occurred
COMMENTS /OTHER ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
4. / What oncological treatments to reduce the risk of pathological fracture have your patients received in the last 12 months?
Single fraction of radiotherapy
Multiple fractions of radiotherapy
Bisphosphonate therapy
Denosumab therapy
COMMENTS /OTHER ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
5 / What would trigger you to advise referral/refer a patient with bone metastases or bone pain to an orthopaedic surgeon?
(Please tick all that apply)
i)Uncertain cause of probable bone/joint pain
ii)Night pain
iii)Severe pain
iv)Plain X-Ray result
v)MRI/CT imagingresult
vi)Site of pain or metastases 
Please specify which sites would prompt orthopaedic referral………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
Please give any additional information regarding your selections
………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
6 / What would trigger you to advise referral/refer a patient with bone mets or pain to an oncologist?
(Please tick all that apply)
i)Uncertain cause of probable bone/joint pain
ii)Night pain
iii)Severe pain
iv)Plain X-Ray result
v)MRI/CT imaging result
vi)Site of pain or metastases 
Please specify which sites would prompt oncological referral ………………………………………………………………….………..
Please give additional information regarding your selections
……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
7. / How would you decide whom to refer to first, an oncologist or an orthopaedic surgeon?
……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
8. / How would you assess risk of fracture? ………………………………………………………..……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
9. / What guidelines are you aware of to assess risk of pathological fracture? …………………….…………………………………………………………………………………………………..…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
10. / Do you think there is a minimal likely prognosis needed for referral to an orthopaedic surgeon to be appropriate?
Yes
No 
Don`t know 
If so what duration would that be? …………………………………………………………………………………………………..…………………………………………………………………………………
11. / Do you think there is a minimal likely prognosis needed for referral to an oncologist to be appropriate?
Yes
No 
Don`t know 
If so what duration would that be?……………………………………………………………………………………………………………………………………………………………………………………
12. / Does your Trust have a Lead Orthopaedic surgeon for metastatic disease affecting the limbs?
Yes
No 
Don`t know 

Please send completed responses to:

Dr Andrew Khodabukus

Academic Clinical Fellow & Specialty Registrar in Palliative Medicine

Specialist Palliative Care,

Linda McCartney Centre,

Royal Liverpool University Hospital,

Prescot Street,

Liverpool,

L7 8XP.

Tel: 0151 706 2274

Fax: 0151 706 5688

Email:

Alternatively, this survey can be completed online at: