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A 12-clinic randomized trial found more advance care planning documentation at 12 months among older adults with advanced chronic kidney disease who viewed a treatment video and recorded their preferences. The study measured documentation and treatment choices, not whether care ultimately matched patients’ goals.
A video decision aid paired with a patient-recorded statement was associated with higher 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, records showed planning documentation for 56.6% of participants offered the intervention, compared with 40.0% receiving usual care.
The multicenter trial, led by Angelo E. Volandes of Dartmouth Health and colleagues, enrolled 453 adults at 12 outpatient clinics. Researchers assigned 228 participants to the intervention and 225 to usual medical care. The study was published to coincide with Kidney Week, the American Society of Nephrology’s annual meeting held Oct. 21–25 in Denver.
Participants in the intervention group watched a certified video explaining three treatment options for advanced kidney disease. They then recorded a video declaration describing their goals, values and treatment preferences; that statement was sent to their treating clinician. The control group continued with usual care, rather than receiving the study’s video-and-recording process.
At 12 months, documentation of a discussion about treatment options for kidney failure was also more common in the intervention group: 46.1%, compared with 31.6% in the control group. After viewing the video, 13.2% of intervention participants were undecided about treatment, versus 41.3% of controls. Conservative kidney management was the preferred option for 50.7% of the intervention group and 31.8% of the control group. These figures describe recorded planning and stated preferences; they do not establish which treatments participants ultimately received.
Planning Preferences Into Kidney Care
Advanced kidney disease can involve decisions among different approaches to care, making it relevant for patients and clinicians to discuss what matters to a person before choices become urgent. The trial suggests a structured video and an opportunity for patients to record their own words may help make those preferences more visible in clinical records.
The difference in documentation could matter when patients see multiple clinicians or face changes in health, because recorded discussions and preferences can inform later conversations. However, the study does not show that better documentation by itself leads to care that matches a patient’s goals. That distinction matters: a plan in the record is a process measure, while goal-concordant care concerns what happens in practice.
The results also show a change in expressed treatment preferences after exposure to the aid, including a larger share choosing conservative kidney management. They should not be read as evidence that one option is best for everyone. Treatment decisions depend on individual circumstances and discussions with qualified clinicians.
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How the Trial Compared Care
Advance care planning involves discussing and documenting a person’s values and preferences for future medical care. In this study, researchers tested a specific addition to routine outpatient care: standardized information about treatment options, followed by a patient-authored video declaration sent to the clinician. The comparison was usual care at the participating clinics.
The research report, titled Video Decision Support and Advance Care Planning in Older Adults With Advanced Kidney Disease, appeared in JAMA Internal Medicine in 2026. The report names Volandes and colleagues as the study authors and gives the DOI as 10.1001/jamainternmed.2026.5989. The findings apply directly to the enrolled population—adults 65 and older with advanced kidney disease—and should not automatically be generalized to younger patients or people with less advanced disease.
“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.”
— Angelo E. Volandes and co-authors
Documentation Is Not Care Received
The reported results do not establish whether participants received treatment consistent with their stated preferences, or whether the intervention affected health outcomes, quality of life or later decision-making. The authors say further research is needed to determine whether increased documentation translates into goal-concordant care.
The source report also does not provide details such as the participants’ demographic breakdown, the full content of the video, or whether the effects differed across clinics or patient subgroups. It is not clear from the available report how long the process took for patients and clinicians, or whether similar results would follow if the approach were used outside the 12 participating clinics. Those questions limit conclusions about broad implementation.
Testing Whether Preferences Guide Care
The next research question is whether the additional documentation changes care in ways that match patients’ goals. Further studies could track treatment decisions and outcomes over time, as well as examine how the approach works in other settings and among different groups of people with kidney disease. The source report does not identify a specific follow-up study or timeline.
For now, the trial supports a limited conclusion: among older adults with advanced kidney disease at the study clinics, the video-and-declaration process was linked to more recorded planning and treatment discussions over 12 months. It does not settle which care approach patients should choose or prove that the intervention improves care outcomes.
Key Questions
What did the video decision aid involve?
Participants watched a certified video describing three treatment options for advanced kidney disease, then recorded a statement about their goals, values and preferences for their clinician.
How much higher was planning documentation?
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 report gives those percentages; they refer to the trial’s groups and 12-month time point.
Did the trial show that patients received care matching their preferences?
No. The reported findings concern documentation, treatment discussions and stated preferences. The authors said more research is needed to determine whether increased documentation leads to care that matches patients’ goals.
Who took part in the study?
The trial included 453 adults aged 65 and older with advanced chronic kidney disease, recruited through 12 ambulatory clinics. The intervention group had 228 participants, and 225 received usual care.
Source: medicalxpress.com
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