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A 12-clinic randomized trial found that older adults with advanced chronic kidney disease who watched a treatment video and recorded their preferences had higher rates of advance care planning documentation at 12 months than patients receiving usual care. The study measured documentation and stated preferences, not whether later care matched patients’ goals.
A randomized trial at 12 clinics found that a video decision aid, followed by a recording of patients’ preferences, was associated with more advance care planning documentation for adults aged 65 and older with advanced chronic kidney disease. At 12 months, documentation was recorded for 56.6% of the intervention group, compared with 40.0% of those receiving usual care, according to research published in JAMA Internal Medicine.
Angelo E. Volandes of Dartmouth Health and colleagues enrolled 453 adults aged 65 or older with advanced chronic kidney disease in a multicenter, parallel-group randomized clinical trial. Of these, 228 participants received the intervention and 225 received usual medical care. The study was published to coincide with Kidney Week, the American Society of Nephrology’s annual meeting in Denver from October 21 to 25.
Participants assigned to the intervention watched a certified video describing three treatment options for advanced kidney disease. They then made a video declaration describing their goals, values and treatment preferences, which was sent to their treating clinician. The comparison group continued with usual care; the report does not describe a matching video or recording activity for that group.
At 12 months, documented discussions of treatment options for kidney failure were also more common in the intervention group: 46.1%, versus 31.6% in the control group. After viewing the video, fewer intervention participants were undecided about treatment, at 13.2% versus 41.3%. More in the intervention group preferred conservative kidney management, at 50.7%, compared with 31.8% in the control group.
More Preferences Entered in Records
Advance care planning can give patients and clinicians a structured opportunity to discuss treatment choices and record what matters to the patient. The trial suggests that combining standardized video information with a patient-authored statement may help prompt those conversations and make preferences more visible to treating clinicians. That may be particularly relevant in advanced kidney disease, where patients face decisions among different approaches to care.
Still, the reported outcome was whether planning and treatment-option discussions were documented, not whether patients ultimately received care that matched their stated goals. The authors said further research is needed to determine whether increased documentation translates into goal-concordant care. The findings support a possible addition to routine care, but do not establish that the intervention improves health outcomes or changes the quality of treatment patients receive.
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How the Trial Compared Care
The study compared usual medical care with a specific two-part intervention: a video depicting treatment options, followed by a recording in which each patient described personal goals and preferences. The recorded declaration was sent to the participant’s clinician. Because the intervention combined education and a patient-created statement, the reported results do not isolate the effect of the video from the effect of recording and sharing preferences.
The research appeared in JAMA Internal Medicine and was reported on October 28, 2026. Its findings concern older adults with advanced chronic kidney disease treated in ambulatory clinics. They should not automatically be applied to younger people, patients at earlier stages of kidney disease, or other health care settings. The supplied report identifies the trial as randomized and multicenter but does not give further detail on participant demographics or follow-up beyond the 12-month results.
“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 Matches Stated Goals
The results do not show whether the higher rate of documentation led to treatment consistent with patients’ recorded preferences, or whether it affected quality of life, clinical outcomes or other measures of care. The report also does not provide details on how long the videos took to complete, how often clinicians acted on the declarations, or whether the intervention’s effects continued beyond 12 months.
It is also unclear from the reported information how participants were selected across the 12 clinics, whether the intervention’s effects differed among patient groups, and how the three treatment options were presented in the video. The study reports group-level differences; it cannot establish that every individual who watched the video changed or clarified a preference.
Testing Whether Planning Changes Care
The authors call for further research to test whether more complete records lead to care that aligns with patients’ goals. A next step would be to track what happens after preferences are documented, including whether clinicians and patients revisit those preferences as health circumstances change. The trial report does not announce a follow-up study or a planned rollout of the video aid.
For now, the published findings offer evidence that the video-and-recording approach can increase documented planning in the clinics studied. Whether it should become a routine part of kidney care will depend in part on further evidence about its effects on the care patients actually receive, alongside its feasibility in other clinical settings.
Key Questions
What did the video decision aid involve?
Participants watched a certified video presenting three treatment options for advanced kidney disease, then recorded a statement about their goals, values and treatment preferences. The recording was sent to their treating clinician.
How much higher was advance care planning documentation?
At 12 months, documentation was recorded for 56.6% of intervention participants and 40.0% of those receiving usual care. The study report does not provide a relative increase; these are the reported group percentages.
Did the intervention change treatment preferences?
The study reported that fewer people in the intervention group were undecided after viewing the video, and a larger share preferred conservative kidney management. Those findings describe recorded preferences; they do not show which treatments participants later received.
Does the study show that care matched patients’ goals?
No. The reported results concern documentation and discussions of treatment options. The authors said more research is needed to determine whether greater documentation leads to goal-concordant care.
Source: medicalxpress.com
