Should the CDC do away with shared clinical decision-making?
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Rather than telling a patient they should get a vaccine, the CDC’s shared clinical decision-making recommendations advise patients to speak to providers about certain vaccines and decide on an individual basis if they should receive them.
After revising its recommendations last week for vaccines against respiratory syncytial virus, the CDC has four remaining shared clinical decision-making recommendations on its immunization schedule:
- Meningococcal B vaccination for adolescents and young adults aged 16 to 23 years;
- Hepatitis B vaccination for adults aged 60 years or older with diabetes;
- HPV vaccination for adults aged 27 to 45 years; and
- 20-valent pneumococcal conjugate vaccination (PCV20) for adults aged 65 years or older who have completed the recommended vaccine series with PCV13 (at any age) and the 23-valent pneumococcal polysaccharide vaccine (administered at age 65 years or older).
We asked Aaron E. Glatt, MD, MACP, FIDSA, FSHEA, chairman of the department of medicine and chief of the division of infectious diseases at Mount Sinai South Nassau in Oceanside, New York, and professor of medicine at the Icahn School of Medicine at Mount Sinai, if the CDC should do away with shared clinical decision-making recommendations altogether.
Glatt: I don't think so. Obviously, the doctor has the expertise and should be providing a medical background for these discussions, but I think the patient needs to play a critical role in this. I think that, in general, everything in medicine should be shared decision-making unless it's in emergency treatment situations.
Patients should be allowed to — and have a right to — understand what they're being asked. Usually, if it's clear-cut and there's no controversy, patients pretty much follow their doctors, but certainly there are many situations where it's not 100% clear-cut and the doctor may advise that there are other opinions.
With some of the vaccine discussions that we're having, for example, it's not 100% clear that every single patient included in the recommendation should get those vaccinations. With that, the patient may want to have some input. I think that's realistic, and I think that's appropriate. It’s not absolute.
It's not a negative to get patient input. I'm not sure why anybody would say no to that. It would seem to me that that's just the smart thing to do. It is always appropriate to get the patient involved.
Reference:
- CDC. Shared clinical decision-making recommendations. https://www.cdc.gov/vaccines/acip/acip-scdm-faqs.html. Accessed June 21, 2024.
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