Putting Evidence Into Practice (PEP)

PEP Rating System Overview

ONS PEP resources are designed to provide evidence-based interventions for patient care and teaching. PEP topic teams of nurse scientists, advanced practice nurses, and staff nurses summarize and synthesize the available evidence in PEP topic areas. These resources can be used to plan individual patient care, patient education, nursing education, quality improvement, and research.

Before you get started, here's a brief overview of PEP terminology.

  • Topics are patient-centered outcomes, such as symptoms, that are selected by a survey of ONS members and determination of availability of evidence in the topic.
  • PEP evidence syntheses answer the question of what interventions are effective in preventing or treating the outcome of interest. Topic teams categorize the interventions by consensus application of the ONS PEP Classification Schema into the categories outlined here. 

Click here for instructions on navigating the ONS PEP webpages. If you have a question about how to apply these PEP topics to your practice, ask a nurse on ONS staff at clinical@ons.org.

Immune-Related Adverse Events With Immunotherapy

Users of the ONS Putting Evidence Into Practice (PEP) information should be aware that the evidence provided here is mostly limited to management of symptoms associated with chemotherapy and radiation therapy. The interventions as categorized here may not be applicable to the same symptoms caused by immunotherapies. The mechanisms of symptom development secondary to immunotherapies, immune-related adverse events (irAEs), are different from those of more traditional treatments, so the interventions identified currently in the PEP evidence may not be applicable and consequences of those symptoms can be much more extreme. Evidence regarding interventions for symptoms associated with immunotherapy is currently limited; however, the critical aspect for management is the immediate identification of the symptom and early intervention (Davies, 2014).

Clinicians should review drug specific information about assessment for and management of irAEs. The need to report all symptoms promptly must be specifically emphasized in patient teaching. Some adverse events can occur months after the end of treatment. Patients must be aware of the need to report late symptoms and continue follow-up throughout and after treatment (Ledezma & Heng, 2014).

Further information about immunotherapy treatment and observed irAEs can be obtained through ONS courses.

Davies, M. (2014). New modalities of cancer treatment for NSCLC: Focus on immunotherapy. Cancer Management and Research, 4, 63–75. doi:10.2147/CMAR.S57550

Ledezma, B., & Heng, A. (2014). Real-world impact of education: Treating patients with ipilimumab in community practice setting. Cancer Management and Research, 4(6), 5–14. doi:10.2147/CMAR.S52543


Recommended for Practice

Likely to Be Effective

Interventions for which effectiveness has been demonstrated from a single rigorously conducted controlled trial, consistent supportive evidence from well-designed controlled trials using small samples, or guidelines developed from evidence and supported by expert opinion

Benefits Balanced With Harm

Interventions for which clinicians and patients should weigh the beneficial and harmful effects according to individual circumstances and priorities

Effectiveness Not Established

Interventions for which insufficient or conflicting data or data of inadequate quality currently exist, with no clear indication of harm

Effectiveness Unlikely

Interventions for which lack of effectiveness has been demonstrated by negative evidence from a single rigorously conducted controlled trial, consistent negative evidence from well-designed controlled trials using small samples, or guidelines developed from evidence and supported by expert opinion

Not Recommended for Practice

Expert Opinion

Low-risk interventions that are consistent with sound clinical practice, suggested by an expert in a peer reviewed publication, and for which limited evidence exists (An expert is an individual who has published peer reviewed material in the domain of interest.)


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