TL;DR
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In a 12-clinic randomized trial, 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 those receiving usual care. The study measured documentation and treatment preferences; it did not establish whether the approach led to care that matched patients’ goals.
A video decision aid paired with patient-recorded statements was associated with higher advance care planning documentation among older adults with advanced chronic kidney disease, according to a randomized trial published in JAMA Internal Medicine. At 12 months, records documented advance care planning for 56.6% of participants assigned to the video intervention, compared with 40.0% receiving usual care.
The multicenter trial included 453 adults aged 65 and older with advanced kidney disease, recruited at 12 ambulatory clinics. Researchers assigned 228 participants to the intervention and 225 to usual medical care. The intervention group watched a certified video describing three treatment options for advanced kidney disease, then made a video declaration outlining their goals, values and treatment preferences. The recording was sent to each participant’s treating clinician.
At 12 months, documentation of discussions about treatment options for kidney failure was also more frequent in the intervention group: 46.1%, compared with 31.6% in the control group. These figures describe what was documented in medical records; they do not by themselves show whether discussions occurred more often outside the record or whether patients ultimately received care matching their stated preferences.
After viewing the video, 13.2% of intervention participants were undecided about treatment, compared with 41.3% of controls. A larger share of the intervention group preferred conservative kidney management—50.7%, versus 31.8% in the control group. The report provides these group results but does not establish that every participant’s preference remained unchanged or led to a particular treatment decision.
How the Aid Changed Planning Records
Advance care planning gives patients an opportunity to discuss their values and preferences for future care, while making those preferences available to clinicians. For people with advanced kidney disease, treatment decisions can include different approaches to managing kidney failure. The trial suggests that standardized video information, followed by a patient-authored statement, may help make those discussions and preferences more visible in the medical record.
The difference in documentation is meaningful as a care-process result: records more often contained planning information in the intervention group at the one-year mark. But documentation is not the same as goal-concordant care. The researchers said further work is needed to determine whether more recorded plans translate into treatment that reflects what patients want. The findings also do not show that the intervention improves health outcomes or is appropriate for every patient.
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Trial Design and Kidney Week
The study was led by Angelo E. Volandes of Dartmouth Health in Lebanon, New Hampshire, and colleagues. It was published in JAMA Internal Medicine in 2026 and reported in connection with Kidney Week, the American Society of Nephrology’s annual meeting held in Denver from October 21 to 25. The journal article 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 comparison was between usual care and a two-part intervention: a video explaining three treatment options, followed by a recording made by the patient and sent to the clinician. The trial therefore tested the combined approach; the reported results do not separate the effect of the video from the effect of recording and sharing a declaration. The findings apply to the older adults with advanced disease enrolled at the participating clinics, not automatically to younger patients or people at earlier stages of kidney disease.
“Further research is needed to determine whether increased documentation translates into goal-concordant care.”
— Angelo E. Volandes and colleagues, the study authors
Questions Beyond the Medical Record
The reported results do not show whether increased planning documentation led to care that matched patients’ preferences, or whether it affected health outcomes, quality of life or use of particular treatments. The authors specifically call for further research on the relationship between documentation and goal-concordant care.
It is also unclear from the reported findings how durable participants’ stated preferences were, whether patients or clinicians changed decisions over time, and how the intervention might work in clinics beyond the 12 in the trial. Because the intervention combined video education with a patient-created declaration, the results do not identify which component contributed most to the observed differences. The study reports group-level outcomes, not a guarantee of benefit for any individual.
Further Testing of Patient Goals
The next research question identified by the authors is whether better documentation leads to care aligned with patients’ goals. Future evaluation would need to track what care participants actually receive and compare it with the preferences they recorded, rather than relying only on the presence of documentation in the electronic health record.
The available report does not name a follow-up study or give a timeline for additional results. For now, the randomized trial provides evidence that the combined video-and-declaration approach can increase recorded planning outcomes in the study population; its effects on treatment decisions and patient outcomes remain to be established.
Key Questions
What did the video decision aid include?
It showed three treatment options for advanced kidney disease. Participants assigned to the intervention then recorded their goals, values and treatment preferences, and the recording was sent to their treating clinician.How many people took part in the trial?
The trial included 453 adults aged 65 and older with advanced kidney disease at 12 ambulatory clinics. Of those, 228 were assigned to the intervention and 225 to usual care.What was the difference in planning documentation?
At 12 months, advance care planning was documented for 56.6% of the intervention group and 40.0% of the usual-care group. Documented discussions of kidney failure treatment options were 46.1% and 31.6%, respectively.Does the study prove that patients received care matching their wishes?
No. The reported outcome was documentation in medical records, not whether subsequent care matched patients’ stated preferences. The authors said further research is needed to answer that question.Did the intervention change participants’ treatment preferences?
After viewing the video, fewer intervention participants were undecided than controls, and a larger share preferred conservative kidney management. The study reports group-level preferences; it does not show that every participant changed their choice or that preferences led to a specific treatment.Source: medicalxpress.com
