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A randomized trial involving 453 adults aged 65 and older with advanced chronic kidney disease found higher rates of documented advance care planning after participants watched a treatment video and recorded their preferences. Researchers said it remains unknown whether the increase in documentation leads to care that better matches patients’ goals.
A 12-clinic randomized trial found that older adults with advanced chronic kidney disease were more likely to have advance care planning documented in their medical records after using a video decision aid and recording their preferences. At 12 months, documentation was present for 56.6% of participants who received the intervention, compared with 40.0% receiving usual care, according to results published in JAMA Internal Medicine.
The trial included 453 adults aged 65 and older with advanced chronic kidney disease. Researchers assigned 228 participants to the intervention and 225 to usual medical care. The intervention group watched a certified video describing three treatment options for advanced kidney disease, then made a video statement about their goals, values and treatment preferences. That recording was sent to each participant’s treating clinician.
At the 12-month mark, a documented discussion of treatment options for kidney failure was also more common in the intervention group: 46.1% compared with 31.6% in the control group. The study measured whether planning and discussions were recorded; those figures do not establish that participants ultimately received care matching their stated preferences.
After viewing the video, 13.2% of intervention participants were undecided about treatment, compared with 41.3% of control participants. More intervention participants indicated a preference for conservative kidney management—50.7%, versus 31.8% in the control group. These reported preferences are group-level results and do not, by themselves, show which treatments participants later received.
More Preferences Entered in Records
Advance care planning can help patients communicate their priorities about future treatment, while giving clinicians and families a record to refer to as illness progresses. The trial suggests a structured video and a patient-authored recording may help prompt those conversations and make preferences more visible in the medical record for older adults with advanced kidney disease.
The findings matter because documentation is not the same as goal-concordant care. A preference recorded today may change, and a medical record alone cannot show whether a later treatment decision reflects that preference. The authors said further research is needed to determine whether greater documentation translates into care aligned with patients’ goals.
The study authors described the approach as a possible addition to routine kidney care, rather than evidence that it improves health outcomes or should replace conversations with clinicians. The trial reported differences in recorded planning and treatment preferences; it did not establish that the video reduced hospitalizations, changed survival, or improved quality of life.
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How the Trial Was Conducted
The study was a multicenter, parallel-group randomized clinical trial conducted in 12 ambulatory clinics. Random assignment allowed researchers to compare the video-and-recording approach with usual medical care across the two groups. The study focused on adults aged 65 and older with advanced chronic kidney disease, so its results may not apply directly to younger patients or people at earlier stages of kidney disease.
The paper, by Angelo E. Volandes and colleagues, was published in JAMA Internal Medicine in 2026. The report appeared alongside Kidney Week, the annual meeting of the American Society of Nephrology, held October 21–25 in Denver. The journal article is titled “Video Decision Support and Advance Care Planning in Older Adults With Advanced Kidney Disease.”
In this trial, the video described treatment options and was followed by a recording made by the patient. That combination is the intervention being evaluated; the results do not isolate the effect of the video from the effect of making and sharing a personal statement.
“Further research is needed to determine whether increased documentation translates into goal-concordant care.”
— The study authors
Whether Care Matches Recorded Goals
The study results show higher rates of documented planning and discussion, but the report does not establish whether clinicians later followed participants’ recorded preferences. The authors explicitly said further research is needed to test whether increased documentation translates into goal-concordant care.
The available report also does not provide details on how often participants watched the video, completed a recording, or revised their preferences over time. It does not describe whether the intervention’s effects varied by clinic or by participant characteristics. Because the intervention combined education with a patient-created declaration, the separate contribution of each component is also unclear.
The findings concern adults aged 65 and older with advanced kidney disease in ambulatory clinics. Whether the same approach would have similar results in other age groups, care settings or stages of chronic kidney disease has not been established by the reported trial.
Testing Effects on Later Care
The next research step identified by the authors is to determine whether higher documentation rates result in care that reflects patients’ goals. That requires looking beyond whether a preference appears in a record to what happens when treatment decisions arise, and whether patients’ preferences remain current.
The report does not announce a follow-up study or a planned wider rollout. For now, the published trial provides evidence about documentation at 12 months and recorded treatment preferences, not a final answer about clinical outcomes. The article was published in JAMA Internal Medicine in 2026, with the findings reported on October 28.
Key Questions
What did the video decision aid involve?
Participants watched a certified video describing three treatment options for advanced kidney disease. They then recorded a statement about their goals, values and preferences, which was sent to their treating clinician.
How much more common was advance care planning documentation?
At 12 months, documentation was recorded for 56.6% of the intervention group and 40.0% of the usual-care group. The trial report gives these rates for that time point; it does not establish that the documentation led to different treatment outcomes.
Did the study show that patients received care matching their preferences?
No. The study found more planning documentation and recorded discussions, but the authors said further research is needed to find out whether that translates into care aligned with patients’ goals.
Who took part in the trial?
The trial enrolled 453 adults aged 65 and older with advanced chronic kidney disease at 12 ambulatory clinics. The results do not establish whether the approach works similarly for younger people or patients at earlier stages of kidney disease.
Source: medicalxpress.com
