TL;DR
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A randomized trial across 12 clinics found that older adults with advanced chronic kidney disease who viewed a treatment video and recorded their preferences had higher rates of advance care planning documentation after 12 months than participants receiving usual care. The study measured documentation and treatment preferences, not whether later care matched patients’ goals.
A video decision aid paired with patient-recorded preferences was associated with more advance care planning documentation among adults aged 65 and older with advanced chronic kidney disease, compared with usual care, in a 12-clinic randomized trial published in JAMA Internal Medicine. At 12 months, documentation was recorded for 56.6% of participants assigned to the video intervention, versus 40.0% of those receiving usual care.
The trial, led by Angelo E. Volandes of Dartmouth Health and colleagues, enrolled 453 older adults with advanced kidney disease. Of these, 228 were assigned to the intervention and 225 to usual medical care. The study was designed to test whether a standardized explanation of treatment options, followed by a patient-created statement, could increase documentation of care preferences in the electronic health record.
Intervention participants watched a certified video showing three treatment options for advanced kidney disease, then recorded a declaration describing their goals, values and treatment preferences. The declaration was sent to their treating clinician. At 12 months, documented discussion of kidney failure treatment options was also more common in the intervention group: 46.1%, compared with 31.6% in the control group.
The researchers also reported differences in preferences recorded after participants viewed the video. Fewer intervention participants were undecided about treatment than control participants, 13.2% versus 41.3%. More participants in the intervention group preferred conservative kidney management, 50.7% versus 31.8%. These results describe recorded preferences and planning; they do not establish which treatment participants ultimately received.
More Preferences Reached the Medical Record
Advance care planning can give patients and clinicians a way to discuss treatment choices before decisions become urgent. For people with advanced kidney disease, the options may involve different approaches to managing kidney failure. The trial’s findings suggest that a video explaining options, combined with a patient-authored statement, may help make such discussions and preferences more visible in routine care.
The practical importance is the change in documented planning, not proof that the intervention improved health outcomes. A preference written in a record may support later conversations, but documentation alone does not show that clinicians followed the preference or that care aligned with a patient’s goals. The authors said further research is needed to establish whether increased documentation translates into goal-concordant care.
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How the Kidney Care Trial Worked
The study was a multicenter, parallel-group randomized clinical trial conducted at 12 ambulatory clinics. Random assignment placed participants in either usual care or the video intervention, allowing the researchers to compare the groups’ planning records over 12 months. The intervention combined education about treatment options with a direct way for patients to communicate their own priorities to clinicians.
The report was published in JAMA Internal Medicine and appeared in connection with the American Society of Nephrology’s Kidney Week meeting in Denver, held Oct. 21–25. The paper is titled “Video Decision Support and Advance Care Planning in Older Adults With Advanced Kidney Disease” and carries DOI 10.1001/jamainternmed.2026.5989. The findings concern older adults with advanced disease and should not automatically be generalized to younger patients or people at earlier stages of chronic kidney disease.
““While further research is needed to determine whether increased documentation translates into goal-concordant care, these findings suggest that standardized education paired with patient-authored statements of preferences is a feasible addition to routine CKD care.””
— The study authors
Whether Recorded Choices Shape Care
The reported outcomes do not show whether the intervention changed treatment decisions, health outcomes or quality of life, or whether care received matched the preferences participants recorded. The authors specifically called for further research on goal-concordant care. The report also does not provide enough detail to determine how durable the planning records were beyond the 12-month assessment or how the intervention might work in clinics outside the study.
The preference figures reflect participants’ responses after viewing the material; they should not be read as evidence that the video itself caused a lasting change in what patients wanted. The study compared groups assigned to different care approaches, but the available report does not establish the reasons behind individual preferences or how they evolved over time.
Testing Whether Plans Guide Treatment
The next research step identified by the authors is to assess whether higher rates of advance care planning documentation lead to care that reflects patients’ stated goals. That would require examining what happens after plans are recorded, including subsequent discussions and treatment decisions. The report does not specify a timeline for such studies or announce a follow-up trial.
For now, the findings offer evidence that the video-and-declaration approach can increase recorded planning in the population studied. Whether it should become part of broader kidney care practice will depend on further evidence about its effects beyond documentation and on how well the approach fits different patients and clinical settings.
Key Questions
What did the video intervention involve?
Participants watched a certified video showing three treatment options for advanced kidney disease, then recorded a statement about their goals, values and preferences. The statement was sent to their treating clinician.
How much higher was planning documentation?
At the 12-month assessment, advance care planning was documented for 56.6% of the intervention group and 40.0% of the usual-care group. Those are the study’s reported group rates.
Did the trial show that patients received care matching their wishes?
No. The reported results concern documentation and recorded treatment preferences. The authors said more research is needed to determine whether the increase in documentation leads to care that matches patients’ goals.
Who took part in the study?
The trial included 453 adults aged 65 and older with advanced chronic kidney disease at 12 ambulatory clinics. The findings may not apply in the same way to younger people or patients with less advanced disease.
Source: medicalxpress.com
