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A randomized trial involving 453 adults aged 65 and older with advanced chronic kidney disease found higher rates of advance-care planning documentation after patients watched a treatment video and recorded their preferences. The study measured documentation and treatment discussions, not whether later care matched patients’ stated goals.
A video decision aid paired with patient-recorded statements of treatment preferences was associated with more advance-care planning documentation among adults aged 65 and older with advanced chronic kidney disease, according to a randomized trial published in JAMA Internal Medicine. At 12 months, records showed advance-care planning for 56.6% of intervention participants, compared with 40.0% who received usual care.
The multicenter study enrolled 453 adults at 12 outpatient 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 created a video statement about their goals, values and treatment preferences. The recording was sent to each participant’s treating clinician.
At 12 months, the intervention group also had a higher rate of documented discussion about treatment options for kidney failure: 46.1% versus 31.6% in the control group. After viewing the video, 13.2% of intervention participants were undecided about treatment, compared with 41.3% of controls. Conservative kidney management was preferred by 50.7% of the intervention group and 31.8% of the control group.
The study, led by Angelo E. Volandes of Dartmouth Health and colleagues, was published in JAMA Internal Medicine alongside the American Society of Nephrology’s Kidney Week meeting, held Oct. 21-25 in Denver. The reported results concern care planning and documentation; they do not establish which treatment participants ultimately received or whether their care matched their preferences.
How the Video Changed Care Planning
Planning ahead can give patients and clinicians a clearer record of what matters to a person if kidney disease progresses or treatment decisions become more difficult. The trial suggests that combining standardized information with a patient’s own recorded preferences may prompt more documented conversations than usual care alone.
The change in treatment preferences is also relevant to clinical discussions. Fewer participants who saw the video were undecided, and more chose conservative kidney management in the study’s reported preference measure. That does not show that the video is right for every patient or that one treatment choice is better. Rather, the findings point to a potential way to help patients understand options and communicate their priorities.
Documentation is an intermediate outcome, not proof of better health or care that aligns with a patient’s goals. The authors said further research is needed to determine whether increased documentation translates into goal-concordant care. The results should be read as evidence about planning and recorded discussions, not clinical outcomes.
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Trial Design and Kidney Care
The trial focused on adults 65 years and older with advanced chronic kidney disease, a population that may face decisions about treatment options as kidney failure develops. Advance care planning is the process of discussing and documenting a person’s values and preferences for future care. In this study, the researchers examined whether a video explaining treatment choices, followed by a patient-created declaration, changed how often those plans were documented.
Participants were recruited across 12 ambulatory clinics and assigned to either the video intervention or usual care. The study’s reported outcomes included electronic health record documentation at 12 months, recorded discussions of kidney-failure treatment options, and participants’ treatment preferences after viewing the video. The trial was published in 2026, with its release timed to Kidney Week, the annual meeting of the American Society of Nephrology.
“Further research is needed to determine whether increased documentation translates into goal-concordant care.”
— Angelo E. Volandes and colleagues, the study authors
What the Trial Did Not Measure
The reported findings do not show whether participants ultimately received the treatments they preferred, whether care was consistent with their recorded goals, or whether the intervention affected health outcomes. The authors specifically call for further research on whether more documentation leads to care aligned with patient preferences.
The report also does not provide details on how the intervention’s effects varied among participants or clinics, or whether the results would be similar in younger people or patients with less advanced kidney disease. The supplied study summary does not report those findings, so their relevance beyond the trial population remains unclear.
Follow-Up on Patient-Aligned Care
The study authors said further research is needed to test whether the higher rate of recorded planning results in care that matches patients’ goals. Follow-up studies could examine whether documented preferences are available when treatment decisions arise and whether care received corresponds to those preferences. The current report does not specify a timeline for additional research or describe a planned next trial.
For now, the published results establish that the video-and-recording approach was associated with more advance-care planning documentation and treatment-option discussions over 12 months in the studied group. Whether those changes lead to different care or patient outcomes remains an open question.
Key Questions
What did the video decision aid include?
It showed three treatment options for advanced kidney disease. Participants then recorded a statement describing their goals, values and treatment preferences, which was sent to their clinician.
How many people took part in the trial?
The study included 453 adults aged 65 and older with advanced chronic kidney disease across 12 outpatient clinics. Of these, 228 received the video intervention and 225 received usual care.
Did the video lead to more advance-care planning documentation?
Yes. At 12 months, documentation was recorded for 56.6% of the intervention group and 40.0% of the usual-care group. The study measured documentation, not whether later care matched the plans.
Does the study show that patients received their preferred treatment?
No. The reported findings do not establish whether participants later received care consistent with their stated preferences. The authors said further research is needed to determine whether increased documentation leads to goal-concordant care.
Source: medicalxpress.com
