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A randomized trial involving 453 adults aged 65 and older with advanced chronic kidney disease found that a video decision aid paired with patient-recorded statements was associated with more advance care planning documentation at 12 months. The study did not establish whether the increased documentation led to care that matched patients’ preferences.
A video decision aid paired with patient-recorded preference statements was associated with more advance care planning documentation among adults aged 65 and older with advanced chronic kidney disease, according to a 453-participant randomized trial published in JAMA Internal Medicine. At 12 months, records showed planning documentation 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, took place at 12 ambulatory clinics. It compared usual medical care with an intervention designed to help participants consider treatment options for advanced kidney disease and communicate their preferences to clinicians.
Among the 228 intervention participants, patients watched a certified video describing three treatment options for advanced kidney disease and then made a video declaration about their goals, values and treatment preferences. That recording was sent to their treating clinician. The 225 control participants received usual care.
At 12 months, documented discussions of kidney failure treatment options were also more common in the intervention group: 46.1% versus 31.6%. 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 intervention participants and 31.8% of controls, the report said.
More Preferences Reached the Medical Record
Advance care planning can give patients and clinicians an opportunity to discuss treatment choices before a health crisis makes decisions more urgent. The trial’s findings suggest that a standardized video, followed by a patient-authored statement, may help older people with advanced kidney disease express preferences and make those discussions more visible in their medical records.
The difference in documentation is relevant because treatment decisions for kidney failure can involve distinct approaches, including conservative management. A recorded preference may give clinicians and care teams information to draw on later. However, the study measured documentation and reported treatment preferences; it does not show that participants ultimately received care consistent with those preferences or that the intervention improved health outcomes.
The authors described the approach as a feasible addition to routine kidney care, while saying more research is needed to establish whether increased documentation translates into goal-concordant care. That distinction matters: recording preferences is one step in planning, not proof that a patient’s choices will guide future treatment in every circumstance.
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How the Trial Compared Care
The report concerns people aged 65 and older with advanced chronic kidney disease, rather than all adults with kidney disease. The researchers tested a combined intervention: a video explaining three treatment options and a video declaration made by the patient. The study therefore evaluates that package, not the effect of video education alone.
The trial was published in JAMA Internal Medicine in 2026 and coincided with Kidney Week, the annual meeting of the American Society of Nephrology held in Denver from October 21 to 25. Its publication details list Volandes and colleagues as the authors and give the DOI as 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 Preferences Changed Care
The reported results do not establish whether the intervention changed the treatments participants received, improved their quality of life, or affected other health outcomes. The authors specifically said further research is needed to determine whether more documentation leads to care consistent with patients’ goals.
The supplied report also does not give details on how long the video intervention took, whether the effect differed among types of participants or clinics, or whether documentation remained available and useful as patients’ health changed. It reports results at 12 months, but does not provide longer-term findings. Those questions limit what can be concluded about how well the approach would work across other settings or over time.
Testing Effects Beyond Documentation
The next research step identified by the authors is to test whether higher rates of documented planning lead to treatment that reflects patients’ stated preferences. Future work could also examine whether the approach remains effective over longer periods and how it fits into routine appointments for people with advanced kidney disease.
For now, the published trial provides evidence that the video-and-declaration approach was associated with more planning documentation and recorded treatment discussions at one year. It does not establish that the intervention should replace clinician conversations or that its results will be the same in other patient groups.
Key Questions
What did the video decision aid include?
Participants watched a certified video describing three treatment options for advanced chronic kidney disease. They then recorded a declaration about their goals, values and treatment preferences, which was sent to their clinician.
How many people took part in the trial?
The trial included 453 adults aged 65 and older with advanced kidney disease across 12 ambulatory clinics. Of these, 228 received the video intervention and 225 received usual care.
How did advance care planning documentation differ?
At 12 months, documentation was recorded for 56.6% of the intervention group, compared with 40.0% of the usual-care group. Documented discussions of kidney failure treatment options were 46.1% and 31.6%, respectively.
Did the study show that patients received care matching their preferences?
No. The reported results measured planning documentation and treatment discussions, but did not establish whether patients ultimately received care consistent with their stated goals. The authors said further research is needed on that question.
Source: medicalxpress.com
