TL;DR
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In a 12-clinic randomized trial, older adults with advanced chronic kidney disease who watched a treatment video and recorded their preferences had more advance care planning documented at 12 months than those receiving usual care. The study measured records and treatment preferences, not whether patients ultimately received care aligned with their goals.
A randomized trial across 12 outpatient clinics found that older adults with advanced chronic kidney disease had more advance care planning documented when they watched a treatment-options video and recorded their preferences. At 12 months, documentation was present for 56.6% of participants in the video-aid group, compared with 40.0% receiving usual care, according to research published in JAMA Internal Medicine.
The study enrolled 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 viewed a certified video describing three treatment options for advanced kidney disease, then made a video statement about their goals, values and treatment preferences. That declaration was sent to each participant’s treating clinician.
At 12 months, the intervention group also had a higher rate of documented discussion about treatment options for kidney failure: 46.1%, compared with 31.6% in the control group. After viewing the video, fewer intervention participants were undecided about treatment, at 13.2% versus 41.3%. More in that group preferred conservative kidney management: 50.7%, compared with 31.8% in the control group.
The study’s primary reported outcomes were documentation and stated preferences. The authors said further research is needed to determine whether greater documentation results in care that matches patients’ goals. The findings were published by Angelo E. Volandes and colleagues in October 2026, with DOI 10.1001/jamainternmed.2026.5989.
Making Kidney Treatment Preferences Visible
Advanced kidney disease can involve decisions among different approaches to treatment. The trial suggests that a structured video explanation paired with a patient-authored statement may help patients and clinicians record those preferences before decisions are needed. The difference in documented planning matters because a preference that is discussed but not recorded may be harder for care teams to reference later.
Still, more documentation is not the same as proof of better or goal-concordant care. The results show changes in records, discussions and reported preferences; they do not establish that patients later received the treatment they wanted or experienced improved health outcomes. The intervention also combines two components—a video and a recorded declaration—so the reported results do not establish which component contributed most.
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How the Trial Tested Video Planning
Advance care planning involves communicating and documenting a person’s values and preferences about future care. In this study, the researchers tested a specific approach for people aged 65 and older with advanced chronic kidney disease: a certified video explaining three treatment options, followed by a patient-created recording for the treating clinician.
The comparison group received usual medical care rather than the study’s video-and-declaration package. The trial took place at 12 ambulatory clinics and was published in JAMA Internal Medicine to coincide with the American Society of Nephrology’s Kidney Week meeting in Denver, held October 21–25. The reported figures describe outcomes at the 12-month mark.
“Further research is needed to determine whether increased documentation translates into goal-concordant care.”
— Angelo E. Volandes and colleagues, the study authors
Whether Records Change Later Care
The report does not establish whether participants ultimately received care consistent with their stated goals, or whether the intervention affected clinical outcomes, quality of life or use of particular treatments. The authors explicitly say more research is needed to assess goal-concordant care.
The supplied study summary also does not provide details on how the intervention performed across different clinics or patient groups, how long the recorded declarations remained accessible to clinicians, or whether patients’ preferences changed after the recording. It does not separate the effect of the video from the effect of creating and sharing a declaration. These questions limit what can be concluded about how the approach would work in routine care beyond the trial.
Testing Effects Beyond Documentation
The next research step identified by the authors is to test whether higher rates of advance care planning documentation lead to treatment that better matches patients’ goals. That would require following patients beyond the recording and documentation stage and assessing care decisions against their expressed preferences.
The report does not announce a specific follow-up trial or a schedule for further results. For now, the published findings support the approach as a possible addition to routine kidney care, while leaving its effect on later treatment and patient outcomes unresolved.
Key Questions
What did the video aid include?
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 many people took part?
The trial included 453 adults aged 65 and older with advanced chronic kidney disease: 228 in the intervention group and 225 receiving usual care.
How did advance care planning documentation differ?
At 12 months, documentation was recorded for 56.6% of the intervention group and 40.0% of the usual-care group. The study also found more documented discussions of kidney failure treatment options in the intervention group.
Does the study show patients received care matching their wishes?
No. The reported findings concern documentation, treatment discussions and stated preferences. The authors said further research is needed to determine whether increased documentation leads to care aligned with patients’ goals.
Source: medicalxpress.com
