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In a 12-clinic randomized trial, older adults with advanced chronic kidney disease who watched a treatment-options video and recorded their preferences had higher rates of advance care planning documentation at 12 months. The study found more documented discussions and fewer participants undecided about treatment, but did not establish whether the intervention led to care that 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, according to a randomized trial published in JAMA Internal Medicine. At 12 months, documentation was recorded for 56.6% of participants offered the intervention, compared with 40.0% receiving usual care.
The multicenter trial enrolled 453 adults with advanced kidney disease 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 statement about their goals, values and treatment preferences. That statement was sent to the participant’s treating clinician.
At 12 months, the intervention group also had a higher rate of documented discussions about treatment options for kidney failure: 46.1%, compared with 31.6% in the control group. After watching the video, fewer intervention participants were undecided about treatment, at 13.2% versus 41.3%. More selected conservative kidney management as their preference: 50.7% versus 31.8%.
The study was led by Angelo E. Volandes of Dartmouth Health in Lebanon, New Hampshire, and colleagues. It was published to coincide with Kidney Week, the American Society of Nephrology’s annual meeting held in Denver from Oct. 21 to 25. The findings show a difference in recorded planning and stated preferences; they do not establish which treatment participants ultimately received.
More Preferences Entered Into Care Records
Advance care planning can give patients and clinicians a record of a person’s priorities when discussing possible future care. In this trial, the video and patient-authored statement were linked to higher rates of documented planning and treatment discussions, two measures that can help make preferences visible to the care team.
The results may matter for older people facing decisions about advanced kidney disease, including whether to pursue kidney failure treatment or conservative management. The intervention also offers a structured way to present options and invite patients to express what matters to them. But more documentation is not the same as care that follows a patient’s goals. The researchers say more work is needed to determine whether the increase in records translates into goal-concordant care.
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How the Kidney Care Trial Worked
The research was a parallel-group, randomized clinical trial conducted in outpatient clinics. Participants were adults aged 65 or older with advanced chronic kidney disease. Those in the control group received usual medical care; the intervention combined standardized information about three treatment options with a statement created by the patient and shared with their clinician.
The publication, titled “Video Decision Support and Advance Care Planning in Older Adults With Advanced Kidney Disease,” appeared in JAMA Internal Medicine in 2026. Its findings relate specifically to the enrolled older adults with advanced disease and to the study’s measures of documentation, discussions and preferences. They should not be taken as evidence that the same effects would occur in younger patients, people at other stages of kidney disease or different care settings.
“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 Care Matched Patient Goals
The reported results do not show whether patients ultimately received treatment consistent with the preferences they stated or whether the intervention changed health outcomes. Goal-concordant care remains unconfirmed, and the authors call for further research on that question.
The source report also does not provide details on how long the video-and-statement process took, whether patients’ preferences changed over time, or how consistently clinicians used the statements in later decisions. The findings are specific to the trial population and setting; their reach beyond older adults with advanced kidney disease in ambulatory clinics is not established by the information reported.
Testing Effects on Care Received
The next research step identified by the authors is to determine whether improved documentation leads to care that aligns with patients’ stated goals. Further studies could track how preferences are used in clinical decisions and whether they remain current as a person’s health or priorities change. No follow-up study or timeline was specified in the source report.
For now, the trial supports the finding that a video aid paired with a patient-created statement can be incorporated into a care-planning process and is associated with higher documentation rates. It does not establish that the approach improves survival, quality of life or other patient outcomes.
Key Questions
What did the video decision aid include?
It showed three treatment options for advanced kidney disease. Participants who received it then recorded a statement about their goals, values and treatment preferences, which was sent to their clinician.How much higher was advance care planning documentation?
At 12 months, documentation was recorded for 56.6% of the intervention group and 40.0% of the usual-care group.Did the study show that patients received care matching their preferences?
No. The study reported documentation, treatment discussions and stated preferences. The authors said further research is needed to find out whether increased documentation leads to goal-concordant care.Who took part in the trial?
The trial included 453 adults aged 65 and older with advanced chronic kidney disease, recruited at 12 ambulatory clinics.Source: medicalxpress.com
