Contextualizing Shared Clinical Decision-Making Recommendations for Immunization

The 2015 MenB recommendation for healthy adolescents in the US codified SCDM as a category of immunization guidance, applicable where data gaps exist, population-level disease burden is low, individual disease impact is high, and/or routine vaccination is cost-prohibitive, but where vaccine availability is desirable. The SCDM process, however, was developed for different situations-those with high-stakes outcomes and no preferred intervention, where the choice between potentially risky treatment options is highly dependent on patient preferences. This juxtaposition, along with other factors, led to confusion over how SCDM recommendations should be operationalized. Classic SCDM scenarios (eg, lumpectomy versus mastectomy) differ markedly from vaccine-related scenarios (eg, whether to receive the MenB vaccine) in terms of the magnitude of relevant probabilities, effects of loss versus gain framing, degrees of uncertainty and risk, source of equipoise, and preference sensitivity. SCDM recommendations should be seen as nuanced, rather than weaker versions of, routine recommendations.