ONS Guidelines™

ONS Guidelines Overview

Clinical practice guidelines provide evidence-based symptom management recommendations for patient care. Guidelines incorporate published research with expert consensus on the certainty of the evidence, the balance of benefits and harms and patient preferences and values. Created with rigorous methodology, the guideline recommendations can be utilized by nurses and other oncology health care professionals, patients, and policy makers with a goal of improving care for patients with cancer.

ONS Guidelines™ have been reviewed and accepted by ECRI Guidelines Trust®, a publicly available web-based repository of objective, evidence-based clinical practice guideline content.  ECRI’s TRUST (Transparency and Rigor Using Standards of Trustworthiness) Scorecard assesses clinical practice guidelines against the Institute of Medicine standards of trustworthy guidelines. Please visit ECRI Guidelines Trust to view available scorecards for ONS Guidelines.

Endorsed Guidelines

Endorsed Guidelines 

  • Guidelines will be added as they are designated as Endorsed. 

Affirmation of Value Guidelines 

  • Guidelines will be added as they are assigned Affirmation of Value. 

Refer to the ONS Guidelines Endorsement Program section for more information.

ONS Guidelines Methodology

Guideline International Network (GIN)-McMaster Guideline Development Checklist

  • This checklist contains a comprehensive list of topics and items that outline steps to consider when developing guidelines.

National Academies of Science, Engineering and Medicine: Clinical Practice Guidelines We Can Trust

  • This report issued by the Institute of Medicine (IOM) in 2011 includes eight standards and recommendations that should be incorporated into all clinical practice guidelines to ensure they are unbiased, scientifically valid, trustworthy and that they characterize the quality of evidence and strength of clinical recommendations.

ONS Guidelines in Development

ONS is interested in your thoughts and expertise on our current guidelines as well as topics that we could address in future guidelines. Share your ideas by emailing help@ons.org.

Guideline Resources

Oncology Nursing Podcast Episode 76: ONS Guidelines Will Answer Key Symptom Management Questions

This podcast discusses the ONS Guidelines, the process by which they were developed, and how they will influence practice for nurses and clinicians throughout the oncology community



  • GRADEpro is a tool to assist guideline developers in enabling and aiding collaboration and management of guideline development teams.

GRADE website

  • The Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group is a collaboration of people with an interest in developing a common, sensible and transparent approach to grading the quality or certainty of evidence and strength of recommendations.

GIN website

  • Guidelines International Network is an organization to lead, strengthen and support collaboration in guideline development, adaptation, and implementation globally. It includes several resources and opportunities for health care professionals interested in networking and collaborating in guideline development.


  • AMSTAR is an instrument to critically appraise systematic reviews of randomised and non-randomised studies of health care interventions and is used by guideline developers when assessing a body of evidence.

Guideline Endorsement Process

The purpose of the ONS Guideline Endorsement Program is to: 

  • Assign value to existing oncology guidelines via a formal quality and content review with an ONS Expert Panel. 
  • Promote harmonized recommendations and reduce competing and incompatible guidelines and redundant development efforts.   
  • Promote standardized high-quality methodology for guideline development in oncology and resources that amplify excellence in oncology nursing care.  

Guideline endorsement submissions can be made by the originating organization by completing the ONS Guideline Endorsement application. Topics will be triaged and addressed according to ONS clinical priorities, and submitted guidelines will be reviewed by a panel of volunteer subject matter experts. 

Submitted guidelines will be reviewed for quality and rigor of development using the Appraisal of Guidelines for Research Evaluation II (AGREE II) instrument. Key items will be evaluated within 6 domains: scope and practice, stakeholder involvement, rigor of development, clarity of presentation, applicability, and editorial independence. Panel members will consider ratings within the domains and make the final judgment on quality and recommendation for use of the proposed Guideline. 

Guidelines are rated based on current state, without modification, and after review are designated as Endorsed, assigned Affirmation of Value (AoV), or designated Not Endorsed. 

  • Endorsed: ONS fully endorses the guideline in the current state.  
  • Affirmation of Value (AoV): The Guideline has an overall benefit to oncology nurses in the current state with some qualifying limitations (i.e., strengths and limitations of the body of evidence are not clearly described, implementation recommendations are incomplete).   
  • Not Endorsed: ONS does not endorse the Guideline. 

A summary will be developed by the panel and shared with the originating body upon designation of Endorsement, AoV, or Not Endorsed. Summaries for Endorsed or AoV assigned Guidelines will be posted to ons.org directing members to the Guideline. 

The Seal of Guideline Endorsement or Seal of Guideline Affirmation of Value will be shared with the originating body for publication use for a predefined period. 

Terms and Conditions for ONS Guidelines™

By accessing or using ONS Guidelines, you agree to the Terms and Conditions for ONS Guidelines™. ONS Guidelines are for your personal use only. This means that, among other things, you cannot share ONS Guidelines on your employer’s intranet or integrate ONS Guidelines into your employer’s EHR system. If you would like information about how you or your organization can use ONS Guidelines, please contact licensing@ons.org for licensing and other opportunities.

ONS Symptom Interventions and Guidelines

Summaries of evidence and recommendations for the management of cancer-related symptoms and treatment side effects to improve patient outcomes and optimize clinical care delivery.

View All Symptom Interventions and Guidelines