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Public unclear what CDC-backed shared decision-making is
Many patients misunderstand shared decision-making, a red flag as the CDC now recommends the practice before getting six previously endorsed childhood vaccines.
The Centers for Disease Control and Prevention is officially urging shared clinical decision-making for six previously endorsed shots in the recommended childhood vaccine schedule. But do patients even know what shared decision-making is, or how to engage in it?
Not quite, according to one new survey from the Annenberg Public Policy Center at the University of Pennsylvania.
Indeed, two in five incorrectly think it means it's up to them to reach out to a doctor for a consult, and more think it amounts to an internal family discussion.
To be clear, ACIP says shared clinical decision-making means getting the vaccine was "individually based and informed by a decision process between the healthcare provider and the patient or parent/guardian."
Moreover, shared decision-making has long been heralded as a patient engagement best practice.
As the U.S. healthcare system adjusts to new CDC advice recommending shared decision-making for many previously endorsed vaccines, leaders will need to understand how patients perceive the practice.
The problem is, many patients don't know what it is.
What is shared clinical decision-making?
According to the Patient-Centered Outcomes Research Institute (PCORI), shared decision-making is when patients and providers collaborate on a treatment or medical decision.
"In shared decision-making, patients and clinicians discuss diagnostic or treatment options, including their effectiveness and their potential benefits and harms, in ways that are designed to be easier for patients to understand," PCORI says on its website. "Research has found that shared decision-making can increase patients' satisfaction, result in changes to the care they receive and improve their health outcomes."
Shared decision-making is not a new concept.
Although its origins can be traced back to the 1980s, shared decision-making gained notoriety during the insurgence of value-based care and patient engagement during the 2010s. It's considered a best practice in patient–provider communication.
Shared decision-making has reentered the cultural conversation as part of the CDC's work to redesign the nation's recommended childhood vaccine schedule to reflect those of other wealthy nations.
On Jan. 5, the CDC signed a decision memorandum to get rid of the blanket recommendation for previously recommended shots for flu, rotavirus, COVID-19, meningitis and hepatitis A and B. Instead, the shots should only be automatically given to kids who are high-risk. Otherwise, patients and providers should engage in shared clinical decision-making regarding the vaccines, the agency said.
This move, made without clinical backing, has raised concern among public health experts, particularly regarding whether patients actually understand the process of shared decision-making.
Patients unclear about shared decision-making process
Earlier this year, APPC conducted a survey of nearly 1,700 U.S. adults about their understanding of shared decision-making, particularly as the practice relates to getting a vaccine.
Overall, patients can figure out the concept, with 68% correctly saying that shared decision-making involves a review of their child's medical history with their healthcare provider before determining whether a shot will be beneficial for them. About a fifth acknowledge that shared decision-making means receiving a vaccination might not be a good idea for everyone but could be a good idea for some.
But a shockingly sizeable proportion misunderstand shared decision-making.
For example, 22% said shared decision-making also means "it's up to an individual whether to consult with their healthcare provider before taking a vaccine about whether it would be a good idea."
This could potentially leave some individuals to forego any expert medical advice. In fact, about a quarter of respondents were unaware that a healthcare professional should even be part of the shared decision-making process. Rather, they said they thought shared decision-making could happen with just their family members.
To be clear, the CDC advises patients to practice shared decision-making with their primary care providers, specialists, physician assistants/associates (PAs), nurse practitioners (NPs), registered nurses and pharmacists.
When probed further about which medical professionals they think the CDC suggests for shared decision-making, most respondents correctly chose physician (86%). Another 66% said PAs or NPs, while only 50% said registered nurse and only 33% said pharmacist.
All said, about a tenth of respondents said they don't know what shared decision-making is.
That's cause for concern, considering the CDC is now recommending six previously endorsed shots to now require shared decision-making before receipt. According to Patrick E. Jamieson, the director of APPC's Annenberg Health and Risk Communication Institute, the suggestion of shared decision-making could sow doubt in certain vaccines.
"Expecting parents to engage in shared decision-making with healthcare providers about routine, thoroughly studied childhood vaccinations suggests that the public health community has doubts about the safety and efficacy of these vaccines when it does not," Jamieson said in a statement. "These vaccines have been part of the recommended childhood schedule because the benefits of taking them substantially outweigh the risks."
Also of concern is the limited guidance the CDC gave to providers practices shared decision-making. On its website, the agency says "it's up to the provider" which patients they choose to discuss shared decision-making with. This means patients who might wish to receive a certain vaccine may not get from advice from their provider, should their provider decide the patient doesn't need share decision-making.
As healthcare professionals learn more about this change in childhood vaccine schedule, they will need to ensure every patient has an equitable opportunity to learn about the vaccines that can protect them.
Sara Heath has reported news related to patient engagement and health equity since 2015.
