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A 12-clinic randomized trial found that older adults with advanced chronic kidney disease who viewed a treatment video and recorded their preferences had more advance care planning documentation at 12 months than patients receiving usual care. The study measured documentation and stated preferences; it did not establish whether care ultimately matched patients’ goals.
A video decision aid paired with patients’ recorded 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, documentation was present for 56.6% of participants who received the intervention, compared with 40.0% of those receiving usual care.
The multicenter trial, led by Angelo E. Volandes of Dartmouth Health and colleagues, enrolled 453 older adults with advanced kidney disease across 12 ambulatory clinics. Researchers randomly assigned 228 participants to the intervention and 225 to usual medical care. The report was published to coincide with Kidney Week, held October 21–25 in Denver.
Intervention participants viewed a certified video describing three treatment options for advanced chronic 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 received usual care; the report does not describe an equivalent video-and-declaration exercise for that group.
At 12 months, clinicians had documented a discussion of kidney failure treatment options for 46.1% of the intervention group, versus 31.6% of 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. These results describe recorded planning and expressed preferences, not treatment received or health outcomes.
More Preferences Reached the Medical Record
For people with advanced kidney disease, treatment decisions can involve different approaches to managing kidney failure. The trial suggests that structured video information, followed by a patient-authored statement, may help patients express preferences and give clinicians a record of those discussions. That could make preferences easier to refer to when care decisions arise.
The study’s central measure was documentation in the electronic health record. A higher rate of recorded planning may support communication among patients and care teams, but it does not by itself show that a person received care consistent with their wishes. Nor does the reported comparison establish that every participant made a final treatment decision after watching the video.
The finding is relevant to clinics considering ways to start or record conversations about serious illness. The intervention combined two components—a standardized video and a patient-created declaration—so the report does not isolate how much each part contributed to the results.
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A Trial of Video and Patient Statements
Advance care planning involves communicating a person’s goals and preferences about future care. In this study, investigators tested an approach designed for older adults with advanced chronic kidney disease: provide information about treatment options in a video, then invite patients to state their own values and preferences on camera for their clinician.
The study was a parallel-group randomized clinical trial, meaning participants were assigned to either the intervention or usual-care group. Its 12-month results compare the proportion with documentation or a recorded discussion in each group. The article appeared in JAMA Internal Medicine in 2026 under the title “Video Decision Support and Advance Care Planning in Older Adults With Advanced Kidney Disease” (DOI: 10.1001/jamainternmed.2026.5989).
““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 Preferences
The report does not establish whether the increased documentation led to care consistent with patients’ stated goals. It also does not provide results on survival, quality of life, treatment choices ultimately received, or other clinical outcomes. The authors say further research is needed to assess whether documentation translates into goal-concordant care.
The supplied report does not explain how long the video intervention took, whether its effects differed by patient characteristics, or how results varied across the 12 clinics. It also does not state whether participants’ preferences changed over the 12-month period. The percentages for treatment preference and indecision are reported after viewing the video, while the documentation comparisons are reported at 12 months; they measure different stages and should not be treated as the same outcome.
Testing Effects on Delivered Care
The next research question, identified by the authors, is whether higher documentation rates lead to care that reflects patients’ goals. Further studies could examine the link between recorded preferences and treatment decisions over time, as well as whether the approach works across different clinics and patient groups.
For now, the reported trial provides evidence that the video-and-declaration approach can increase recorded planning in the participating clinics. The report does not give a timeline for additional studies or describe a broader rollout. Patients making kidney-care decisions should discuss individual options and preferences with their treating clinicians; the study evaluates a communication aid, not a substitute for professional medical guidance.
Key Questions
What did the video decision aid include?
It presented three treatment options for advanced chronic kidney disease. Participants then recorded a statement about their goals, values and treatment preferences for their clinician.
How much higher was advance care planning documentation?
At 12 months, documentation was reported for 56.6% of the intervention group and 40.0% of the usual-care group. The report gives these percentages; it does not describe them as a relative increase.
Did the intervention prove patients received care matching their preferences?
No. The study measured documentation and reported treatment preferences. Its authors said further research is needed to determine whether increased documentation translates into care aligned with patients’ goals.
Who took part in the trial?
The trial included 453 adults aged 65 and older with advanced chronic kidney disease, enrolled at 12 ambulatory clinics. There were 228 participants in the intervention group and 225 in the usual-care group.
Source: medicalxpress.com
