Shared decision-making isn’t a new term in healthcare, but it’s recently been propelled into the spotlight as a result of the CDC’s vaccine schedule overhaul. The controversial decision placed many childhood immunizations which were previously universally recommended, including flu and hep B, into categories of conditional recommendation based on “shared clinical decision-making” with a healthcare provider.
All else aside, this change necessitates that patients understand what shared decision-making entails. However, this debacle has shown that public knowledge of shared decision-making is far from complete. That means nurse practitioners who work with children and families weighing immunization decisions must forge workflows around shared decision-making.
Why Patients Are Confused
For years, families have relied on relatively stable signals to interpret vaccine guidance: routine schedules, standardized timing, school requirements, and default inclusion during well-child visits.
Now, many parents are encountering the shared decision-making label for the first time. In an August 2025 survey on shared decision-making for childhood vaccines conducted by the Annenberg Public Policy Center, 1 in 10 respondents were unsure what shared decision-making means. The same survey found that nearly 25% of respondents indicated that shared decision-making means talking with a family member.
Respondents also showed confusion around what kinds of healthcare providers are involved in shared clinical decision making, When polled on the types of healthcare providers that shared-decision making conversations on vaccines could take place with, 86% of respondents included doctors, 66% of responses included nurse practitioners, 50% included RNs, and just 33% included pharmacists.
Some patients interpret shared decision-making as meaning vaccination is primarily a personal or family choice rather than a clinician-guided medical decision. Others assume that if a vaccine were truly important, it would still be labeled routine. These interpretations create friction when families arrive expecting optionality while clinicians are prepared to discuss prevention.
Shared Decision-Making Workflow Tips for Childhood Vaccines
This change necessitates that NPs spend more time contextualizing disease risk and clarifying what the recommendation category does and does not mean. Conversations that were previously embedded into routine workflows may now require explicit framing, justification, and follow-up.
Though practice guidelines may take time to catch up with policy, here are some tips you might consider for your personal workflow when approaching shared decision-making conversations about childhood immunizations.
Anchor the discussion in the disease the vaccine prevents, not in the recommendation category. Briefly explain what the disease looks like in real-world practice, including severity, transmission, seasonality, and who is most affected.
Identify factors that increase risk even when they are not obvious at first glance. This may include daycare or school attendance, household contacts, chronic medical conditions, prematurity, travel, congregate settings, community outbreaks, or barriers to timely care.
Make a clear clinical recommendation when indicated. When the child’s risk is meaningful, state your professional recommendation clearly, using plain language focused on the preventative benefits of an immunization.
Treat shared decision-making as an ongoing process, not a one-time choice. Reassess risk and revisit the discussion as the child’s exposures, age, or community disease patterns change. A deferred vaccine is not a closed conversation, especially when risk is present.
Documentation for Shared Decision-Making
When a vaccine is recommended based on shared decision-making, your documentation shows that you assessed and outlined the risks and that the parent or guardian made a deliberate choice. A simple workflow is as follows:
- State the child’s relevant risks and exposures and note any comorbidities or household risks.
- Counsel families on the benefits of preventing the target disease and the health outcomes associated with that disease.
- Record the family’s questions and the decision (accept/decline/defer) with a follow-up plan.
For nurse practitioners, the shift toward broader use of shared decision-making does not necessarily change what needs to be discussed, but it does change how much time, intention, and documentation are required to do it well.
This article is intended for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Clinicians should consult current research and clinical guidelines before applying any concepts in practice, and patients should always seek personalized advice from their healthcare provider.
