Shared Clinical Decision Making & COVID-19 Vaccination

The Centers for Disease Control and Prevention (CDC) recently changed its COVID-19 vaccination recommendation. Previously a routine recommendation for everyone 6 months and older, the recommendation is now based on ‘individual-based decision making’ – more commonly known as shared clinical decision making (SCDM) – for all adults ages 65 years and older, and for people ages 6 months–64 years with an emphasis that the risk-benefit of vaccination is most favorable for individuals who are at an increased risk for severe COVID-19 disease and lowest for individuals who are not at an increased risk.¹

What is Shared Clinical Decision Making?

The key difference between SCDM recommendations and routine, catch-up, and risk-based recommendations is the lack of a default decision to vaccinate. Unlike vaccinations under those recommendations, SCDM vaccinations are not automatically recommended for all patients in a particular age- or risk-based group. Instead, the health care provider (HCP) and patient make vaccination decisions together based on individual benefits/risks and patient values.² If this sounds familiar, it’s likely because many clinicians already have some version of this conversation with patients!

Regarding SCDM, CDC defines HCPs as anyone who provides or administers vaccines, including “primary care physicians, specialists, physician assistants, nurse practitioners, registered nurses, and pharmacists.”² HCPs can lead discussions of patients’ unique risk/benefit as it relates to COVID-19 and vaccination to assist informed decision making.

Ambiguity can hinder uptake

While SCDM recommendations are intended to engage patients in decision-making, they can introduce confusion among patients and require more time from providers. This can translate to lower vaccination rates compared to routine vaccinations.³

An example of this can be seen with the 13-valent pneumococcal conjugate (PCV13) vaccine, which was changed from a routine to an SCDM vaccine for immunocompetent adults 65 years and older in 2019. In a 2023 retrospective study of PCV13 vaccination rates among Medicare beneficiaries, Vietri et al.³ found that uptake notably decreased following implementation of the SCDM recommendation. Among the study’s >12 million beneficiaries, PCV13 vaccine uptake fell from over 70% of pneumococcal vaccinations prior to SCDM to less than 60% after SCDM.³

Within the healthy/immunocompetent population for whom the recommendation changed, PCV13 vaccine uptake dropped by up to 16-23%. The impact of the recommendation change wasn’t limited to the affected population, though – the high-risk/ immunocompromised population that retained a routine recommendation also experienced an up to 21% reduction in uptake.³

Actions for providers

SCDM centers around informed discussion – emphasizing the role of clinicians as trusted partners in healthcare decision-making. Patients who are eligible for COVID-19 vaccination may be confused about their eligibility or assume that the change to SCDM means that it’s no longer important for them to stay up to date with COVID-19 vaccinations. When seeing a patient at increased risk of severe COVID-19 outcomes, it’s important for providers to focus vaccination conversations on the patient’s unique risk-benefit profile.

The AIMS approach can help start those conversations:

• Announce – Tell the patient that they’re due for an updated COVID-19 vaccination in a clear but friendly manner.
• Inquire – If the patient expresses hesitation about vaccination, ask open-ended questions to understand concerns.
• Mirror – After the patient explains their perspective, paraphrase back what they said to ensure you understand. 
• Secure – Respectfully address any concerns with information tailored to their viewpoint and risk/benefit profile, explaining why you think vaccination is right for them. This can help build confidence in the vaccine and help secure your patient-provider relationship, even if they ultimately decide not to vaccinate.

Put into practice – What SCDM can look like 

HCP [Following discussion of management of the patient’s chronic obstructive pulmonary disease (COPD)]: I’m so glad that you’re open to cutting back on smoking. While you’re here, let’s get you up to date with the latest COVID-19 vaccine. 

PATIENT: No thanks. I’ve been vaccinated before, but I just don’t like vaccines. 

HCP: Why’s that?

PATIENT: They don’t work. Why get one if I’ll get sick anyway? 

HCP: I can understand that – vaccines can seem unnecessary if it’s still possible to get sick. 

PATIENT: Exactly.

HCP: I hear you, but your COPD and smoking history increase your risk of getting really sick from COVID-19.⁵ Adults with chronic lung diseases (CLDs) like COPD are 1.5x more likely to be hospitalized with COVID-19 than those without CLDs.⁶ Severe COVID-19 can significantly increase the risk of acute exacerbation of COPD,⁷ but research has shown that COVID-19 vaccination may lower that risk.⁸

PATIENT: I didn’t know that it could make COPD worse… Can I think about it, though? I’m not sure.  

HCP: Absolutely. I think this is so important that if you decide to get the vaccine, just show up here or at our pharmacy and we’ll get you vaccinated. I want to do everything we can to help avoid your COPD getting worse. 

PATIENT: Hmm alright… I’ll get it today. If I’m cutting back on smoking, I might as well make it worthwhile and try to avoid other risks too.

HCP: Great, I’ll get that ready for you.

Key Takeaways

• SCDM recommendations encourage patient engagement in healthcare decisions but have been associated with reduced vaccination rates.⁴

• Knowing the risk factors for severe COVID-19 can help you identify which patients may have the greatest benefit from vaccination.
• The AIMS approach can be used to help understand and address concerns of vaccine-eligible patients and explain why you think vaccination is the right choice for them.⁴ 

References

1. Centers for Disease Control and Prevention. 2025–2026 COVID-19 Vaccination Guidance. https://www.cdc.gov/covid/hcp/vaccine-considerations/routine-guidance.html. Accessed November 13, 2025.
2. Centers for Disease Control and Prevention. ACIP Shared Clinical Decision-Making Recommendations. https://www.cdc.gov/acip/vaccine-recommendations/shared-clinical-decision-making.html. Accessed November 13, 2025. 
3. Vietri J, et al. Vaccine. 2023;41(36):5211-5215.
4. Parrish-Sprowl J, et al. Front Public Health. 2023;11:1120326.
5. Centers for Disease Control and Prevention. Underlying Conditions and the Higher Risk for Severe COVID-19. https://www.cdc.gov/covid/hcp/clinical-care/underlying-conditions.html.  Accessed November 13, 2025
6. Aveyard P, et al. Lancet Respir Med. 2021;9(8):909–923. 
7. Choi JY, et al. Sci Rep. 2025;15(1):2427.
8. Kim SH, et al. Tuberc Respir Dis (Seoul). 2025;88(3):526-534. 

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