Shared clinical decision making, or individual decision making, has historically been used to provide immunizations that are beneficial for some, but not necessarily all, children. In January 2026, the CDC changed some of their vaccine recommendations (rotavirus, COVID-19, influenza, hepatitis A and B, and meningococcal disease) to shared clinical decision making. While AAP experts disagree with these changes and the AAP still recommends each of these immunizations for all children at the appropriate age, the following information and resources related to shared clinical decision making are being provided.

On this page:

What is Shared Clinical Decision Making (SCDM)?

Shared Clinical Decision Making (SCDM) involves a decision process between the health care provider and patient/caregiver about a vaccine, including the benefits and risks of vaccination. In reality, SCDM is something that most pediatricians already do every day in practice when communicating risks and benefits of immunization, answering questions, and making shared decisions with patients and families. 

Who Can Participate in Shared Clinical Decision Making for Vaccines?

Anyone who provides or administers vaccines including pediatricians, physicians, physician assistants, nurse practitioners, registered nurses, and pharmacists can provide SCDM for vaccines. Additionally, depending on state scope of practice laws, additional health care providers who offer vaccines, including medical assistants, pharmacy techs, and dentists, may also be able to offer SCDM. Please refer to your state’s scope of practice regulations.

Are there Specific Requirements for Shared Clinical Decision Making?

SCDM can be:

  • short or long interaction
  • virtual or in person conversation
  • live or asynchronous (such as a patient portal conversation)
  • involve one conversation or multiple conversations
  • involve one clinician or multiple clinicians

The key elements are that information about vaccine benefits and risks are provided to the patient/family and that the patient/family has the opportunity to ask questions and accept or decline.  

Medical Record Documentation

AAP recommends use of specific language related to shared clinical decision making in medical record documentation. Documentation is recommended that discussion about the vaccine occurred and a decision to vaccinate followed shared clinical decision making. The patient’s desire to receive the protection of vaccination should be adequate, however, notating any additional benefit to the patient is also helpful.

Use the following dot phrase (template language) as a guide:

The patient/caregiver and I engaged in shared clinical decision-making about the benefits and risks of the _________ vaccine. This discussion included an opportunity for them to ask questions. No contraindication to vaccination was identified, and the patient/caregiver and I collaboratively determined the patient would benefit from vaccination.  A vaccine was ordered in the context of shared clinical decision making and educational materials were provided.

(Where relevant and applicable for patients with underlying conditions add) The patient has ________(indicate underlying condition).

Talking with Families

Parents are hearing a lot of information now — much of it is conflicting and misleading. The provider’s role is to cut through that noise and share what science shows so parents can make informed decisions with confidence alongside their pediatricians. It’s important to let families know that the vaccines currently listed as shared clinical decision making are still important and that the science behind these vaccines has not changed.

See the Clinician-Family Immunization Communications FAQs for more guidance on how to talk to families about changes to CDC’s child immunization recommendations.

Resources

AAP:

Common Health Coalition (CHC):

Immunize.org:

Last Updated

02/24/2026

Source

American Academy of Pediatrics