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A randomized trial at 12 clinics found higher rates of documented advance care planning and kidney-failure treatment discussions among older adults with advanced chronic kidney disease who used a video decision aid and recorded their preferences. The study did not establish whether the additional documentation led to care that matched patients’ goals.
A video decision aid paired with patient-recorded statements was associated with more documented advance care planning among adults aged 65 and older with advanced chronic kidney disease, according to a randomized trial published in JAMA Internal Medicine. At 12 months, planning documentation appeared in 56.6% of intervention participants, compared with 40.0% of those receiving usual care.
The multicenter study included 453 participants from 12 ambulatory clinics. Researchers assigned 228 people to the intervention and 225 to usual medical care. The intervention group watched a certified video explaining three treatment options for advanced kidney disease, then made a video declaration describing their goals, values and treatment preferences. The declaration was sent to each participant’s treating clinician.
At 12 months, records also showed a documented discussion of kidney-failure treatment options for 46.1% of the intervention group, compared with 31.6% of the control group. After watching the video, 13.2% of intervention participants were undecided about treatment, compared with 41.3% of control participants. Conservative kidney management was preferred by 50.7% of the intervention group and 31.8% of the control group.
The trial’s reported outcomes concern preferences and documentation in medical records. They do not establish that participants ultimately received care matching those preferences. The research was led by Angelo E. Volandes of Dartmouth Health and published as “Video Decision Support and Advance Care Planning in Older Adults With Advanced Kidney Disease.”
More Preferences Reached the Medical Record
Advance care planning can give patients and clinicians a way to discuss future treatment choices before a health crisis makes those conversations harder. In this trial, the intervention was associated with more recorded planning and more documented discussions about kidney-failure treatment, suggesting that a structured video and a patient-authored statement may help bring preferences into routine clinical records.
The difference matters because a preference that is discussed but not recorded may be difficult for other members of a care team to find later. The study, however, measured documentation and reported treatment preferences—not whether care delivered matched those preferences, or whether the approach changed health outcomes. The authors said further research is needed to determine whether increased documentation translates into goal-concordant care.
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How the Kidney Care Trial Worked
The study focused on adults aged 65 or older with advanced CKD, a population facing decisions about treatment options as kidney disease progresses. It was a parallel-group randomized clinical trial conducted in 12 outpatient clinics, with participants assigned either to usual care or to the video-based intervention.
The intervention combined standardized information about three options for advanced CKD with a chance for participants to express their own priorities on video. The study was published to coincide with Kidney Week, the American Society of Nephrology’s annual meeting held Oct. 21–25 in Denver. The paper appeared in JAMA Internal Medicine in 2026.
“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 Recorded Wishes Shape Care
The reported results do not show whether clinicians acted on the preferences recorded by participants, whether the treatment ultimately received matched those preferences, or whether the intervention affected patient outcomes. The authors explicitly called for further research on whether more documentation leads to care aligned with patients’ goals.
The report also does not provide details on how long participants spent using the aid, whether the effect varied across clinics or patient groups, or how durable the recorded preferences were beyond the 12-month measurement. Those questions limit what can be concluded about the intervention’s wider effects and use in other care settings.
Research Must Track Care Outcomes
The next question for researchers is whether the increase in planning records leads to discussions and decisions that reflect patients’ priorities as their illness progresses. Follow-up studies could track whether clinicians use the declarations, whether preferences change over time, and how often the care provided is consistent with patients’ stated goals.
The trial was published in JAMA Internal Medicine; the source report does not identify a specific next study or timeline. For now, the findings support the feasibility of testing a video aid and patient-created declaration within routine advanced kidney disease care, while leaving its effect on actual treatment decisions unresolved.
Key Questions
What did the video decision aid include?
It presented three treatment options for advanced chronic kidney disease. Participants assigned to the intervention then recorded a statement about their goals, values and treatment preferences for their clinician.
How many people took part in the trial?
The trial included 453 adults aged 65 and older with advanced CKD: 228 in the intervention group and 225 receiving usual medical care.
How did advance care planning documentation differ?
At 12 months, advance care planning was documented for 56.6% of the intervention group and 40.0% of the usual-care group. The study also reported more documented discussions of kidney-failure treatment options in the intervention group.
Does the study prove the video led to care matching patients’ wishes?
No. The reported findings concern documentation, discussions and stated treatment preferences. The authors said further research is needed to establish whether increased documentation results in care that matches patients’ goals.
Source: medicalxpress.com
