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In a randomized trial involving 453 adults aged 65 and older with advanced chronic kidney disease, a video decision aid paired with patient-recorded statements was associated with more advance care planning documentation at 12 months. Researchers said further study is needed to learn whether that documentation leads to care that matches patients’ goals.
A 12-clinic randomized trial found that older adults with advanced chronic kidney disease (CKD) who watched a treatment-options video and recorded their preferences had more advance care planning documentation in their electronic health records than patients receiving usual care. At 12 months, documentation was recorded for 56.6% of the video-aid group and 40.0% of the control group, according to the study published in JAMA Internal Medicine.
The trial included 453 adults aged 65 or older with advanced CKD. Of these, 228 were assigned to the intervention and 225 to usual medical care. The intervention participants watched a certified video presenting three treatment options for advanced kidney disease, then made a video declaration describing their goals, values and treatment preferences. The declaration was sent to the participant’s treating clinician.
At 12 months, the intervention group was also more likely to have a documented discussion of kidney failure treatment options: 46.1% compared with 31.6% in the control group. After viewing the video, fewer intervention participants were undecided about treatment than control participants, 13.2% versus 41.3%. More participants in the intervention group preferred conservative kidney management, at 50.7%, compared with 31.8% in the control group.
The study was led by Angelo E. Volandes, M.D., of Dartmouth Health, and colleagues. It was a multicenter, parallel-group randomized clinical trial conducted in 12 ambulatory clinics. The report appeared in JAMA Internal Medicine in connection with the American Society of Nephrology’s Kidney Week meeting, held in Denver from October 21 to 25.
From Recorded Preferences to Care
The results point to a way of making treatment choices more visible in routine care for older people with advanced CKD. The intervention combined standardized video information with a statement recorded in the patient’s own words, and the trial found higher rates of documented planning and treatment-option discussions. That could give patients and clinicians a clearer record of preferences when considering care for kidney failure.
However, the measured outcomes were documentation and expressed preferences, not whether patients ultimately received care consistent with those preferences. The researchers cautioned that more research is needed to establish whether the increase in records translates into goal-concordant care. The study therefore supports the approach as a possible addition to CKD care, but does not establish its effect on treatment decisions or health outcomes.
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How the Trial Was Designed
Advance care planning involves discussing and recording a person’s values and preferences for future medical care. In this trial, the intervention was more than a video alone: participants viewed information about three treatment options and then created a video declaration for their clinician. The comparison group continued to receive usual medical care.
The findings concern older adults with advanced kidney disease seen in ambulatory clinics. They do not, on the information reported, establish whether the same approach would have similar results for younger patients, people with less advanced CKD or patients in other care settings. The study was published as a research report, with Kidney Week providing the meeting context for its release.
“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 Preferences Shape Treatment
The reported findings do not show whether the higher rate of planning documentation led clinicians to provide care that matched patients’ recorded goals. The authors explicitly said further research is needed to assess that connection. The available report also does not provide details on outcomes such as quality of life, survival, or whether participants later changed their treatment preferences.
It is also unclear from the report whether the intervention’s effects would persist beyond the 12-month follow-up or be reproduced in clinics outside the 12 participating sites. The reported percentages describe trial participants; they do not establish that every patient who views a video will make a decision or complete planning documentation.
Testing Effects on Care
The next key research question is whether increased documentation leads to care that reflects patients’ stated goals. The study authors called for further research on that issue. The report does not specify a follow-up study, a planned expansion to additional clinics or a timetable for further results.
For now, the trial provides evidence about documentation and treatment discussions in this particular group of older adults with advanced CKD. Any wider use or conclusions about patient outcomes would require additional evidence beyond the results reported here.
Key Questions
What did the video decision aid involve?
Participants watched a certified video describing three treatment options for advanced CKD. They then recorded a video statement about their goals, values and preferences, which was sent to their treating clinician.
How many people took part in the trial?
The trial included 453 adults aged 65 or older with advanced CKD: 228 received the video intervention and 225 received usual medical care.
What changed after 12 months?
Advance care planning was documented for 56.6% of the intervention group, compared with 40.0% of the control group. Documented discussions of kidney failure treatment options were also more common in the intervention group, 46.1% versus 31.6%.
Does the study show that patients received care matching their preferences?
No. It measured documentation and treatment discussions, not whether care ultimately matched patients’ goals. The authors said further research is needed to determine whether increased documentation leads to goal-concordant care.
Source: medicalxpress.com
