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A randomized trial at 12 U.S. clinics found that older adults with advanced chronic kidney disease who viewed a treatment video and recorded their preferences had higher rates of advance-care planning documentation at 12 months than patients receiving usual care. The study measured documentation and stated preferences; whether the approach leads to care that matches patients’ goals remains unknown.
A 12-clinic randomized trial found that a video decision aid paired with a patient-recorded statement of treatment preferences was associated with more advance-care planning documentation among adults aged 65 and older with advanced chronic kidney disease (CKD). At 12 months, documentation was recorded for 56.6% of participants who received the intervention, compared with 40.0% of those receiving usual care, according to a study published in JAMA Internal Medicine.
The trial enrolled 453 adults aged 65 or older with advanced CKD. Researchers assigned 228 participants to the intervention and 225 to usual medical care. Those in the intervention group watched a certified video describing three treatment options for advanced kidney disease, then created a video declaration describing their goals, values and preferences. The recording was sent to the participant’s treating clinician.
At the 12-month assessment, researchers also found that documented discussions of treatment options for kidney failure were more common in the intervention group: 46.1% compared with 31.6% in the control group. These figures describe documentation in the electronic health record, not a direct measure of whether participants received the care they preferred.
After viewing the video, 13.2% of intervention participants were undecided about treatment, compared with 41.3% of controls. Conservative kidney management was the stated preference of 50.7% in the intervention group and 31.8% in the control group. The study 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 Enter the Medical Record
Advance-care planning can give patients and clinicians a record of how a person wants treatment decisions handled as illness progresses. The trial’s results suggest a structured video and patient-authored statement can support conversations and make preferences more likely to appear in the electronic health record. That record may help clinicians and care teams refer to a patient’s priorities when discussing kidney failure treatment.
The findings matter because the intervention was tested in routine ambulatory care across 12 clinics, rather than in a single clinical setting. However, the reported outcome was planning documentation. The study does not establish that participants ultimately received treatment consistent with their stated goals, or that the approach changed health outcomes. Documentation is a step in planning, not proof of goal-concordant care.
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How the Kidney Care Trial Worked
The study was a multicenter, parallel-group randomized clinical trial, a design that compares assigned groups to assess an intervention. Participants in the control group continued to receive usual medical care. Participants in the intervention group received both the video decision aid and the opportunity to record their own preferences for their clinician.
The research was published in JAMA Internal Medicine in 2026 and reported in connection with the American Society of Nephrology’s Kidney Week meeting, held in Denver from October 21 to 25. The Medical Xpress report cited the journal article, which has the DOI 10.1001/jamainternmed.2026.5989. The supplied report does not provide additional details on participant demographics beyond age and advanced CKD, or on the specific clinics involved.
“Further research is needed to determine whether increased documentation translates into goal-concordant care.”
— The study authors
Documentation Is Not the Final Outcome
The study report does not show whether the higher documentation rate led clinicians to provide treatment aligned with each participant’s goals. It also does not report whether the intervention changed decisions over time, patient or family experience, kidney-related outcomes, or use of particular treatments. The authors explicitly say more research is needed to establish whether increased documentation results in goal-concordant care.
Details beyond the reported trial design and outcomes are limited in the source material. It does not describe how long participants took to complete the process, whether the video was equally accessible to all participants, or whether the results would apply to younger adults or people receiving care outside the participating ambulatory clinics. The reported differences in treatment preferences should not be taken to mean that one option is appropriate for every patient.
Testing Whether Care Matches Goals
The next research question is whether adding a video aid and patient-recorded preferences to CKD care changes decisions and care in ways that reflect patients’ stated priorities. The study authors call for further research on the link between more complete documentation and goal-concordant care. The supplied report does not identify a follow-up trial or a timeline for additional results.
For now, the findings support the possibility of using the tool as a planning aid, but do not establish it as a replacement for discussion with clinicians. The trial measured outcomes over 12 months; whether the approach can be maintained across other care settings and patient groups remains to be established.
Key Questions
What did the video decision aid include?
It presented three treatment options for advanced CKD. Participants assigned to the intervention then recorded a statement about their goals, values and treatment preferences, which was sent to their clinician.
How much higher 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 study measured documentation in the medical record.
Did the study show that patients received care matching their preferences?
No. The report says the trial found more documentation, but whether this translated into care aligned with patients’ goals remains an open question requiring further research.
Who took part in the trial?
The trial included 453 adults aged 65 and older with advanced CKD at 12 ambulatory clinics. A total of 228 received the video intervention, while 225 received usual medical care.
Source: medicalxpress.com
