Video Decision Support and Advance Care Planning in Older Adults With Advanced Kidney Disease: The VIDEO-KD Randomized Clinical Trial

Why clinicians should know about it

• Picked for Internal Medicine (paper of the day, 24 October 2026): Randomized decision-support trial for advanced CKD care planning

Abstract

IMPORTANCE: Older adults with advanced chronic kidney disease (CKD) face consequential decisions about whether to initiate dialysis, yet advance care planning (ACP), the communication that prepares patients for such decisions, is documented infrequently in ambulatory settings. OBJECTIVE: To determine whether a video decision aid about treatment options for advanced CKD, combined with patient-created video declarations, increases ACP documentation among older adults with advanced CKD. DESIGN, SETTING, AND PARTICIPANTS: This multicenter, parallel-group randomized clinical trial was conducted at 12 ambulatory clinics from June 2021 to March 2025, with 12-month follow-up. Participants were adults 65 years or older with advanced CKD. Outcome assessors were masked to group assignment. Data were analyzed in April 2026. INTERVENTIONS: Intervention participants viewed a certified video decision aid depicting 3 treatment options for advanced CKD (hemodialysis, peritoneal dialysis, and conservative kidney management) and then created a video declaration, a recorded statement of goals, values, and treatment preferences in video, audio, or written format, that was sent to their treating clinician. Control participants received usual medical care. MAIN OUTCOMES AND MEASURES: The primary outcome was ACP documentation in the electronic health record within 12 months of enrollment or death, whichever came sooner. Documentation was ascertained by validated natural language processing-assisted human adjudication. Prespecified secondary outcomes included documented discussion of kidney failure treatment options and stated treatment preferences. RESULTS: A total of 453 patients were included (228 intervention [50.3%] and 225 control [49.7%]; mean [SD] age, 78.8 [6.4] years; 190 women [41.9%]; 4 American Indian or Alaska Native [1.1%], 8 Asian [1.8%], 38 Black [8.4%], 35 Hispanic or Latino [7.7%], 3 Native Hawaiian or other Pacific Islander [0.7%], and 375 White [82.8%] individuals). At 12 months, ACP documentation was higher in the intervention group than the control group (56.6% vs 40.0%; rate difference, 16.6%; 95% CI, 7.5%-25.7%; P < .001), as was documented discussion of kidney failure treatment options (46.1% vs 31.6%; rate difference, 14.5%; 95% CI, 5.6%-23.4%; P = .001). After viewing the video, fewer intervention participants than controls at enrollment were undecided about treatment (30 of 227 [13.2%] vs 92 of 223 [41.3%]), and more preferred conservative kidney management (115 of 227 [50.7%] vs 71 of 223 [31.8%]; P < .001 for the overall distribution). CONCLUSIONS AND RELEVANCE: This randomized clinical trial found that, among older adults with advanced CKD, a video decision aid increased ACP documentation and reduced the proportion of patients who were undecided about treatment. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04347629.

Abstract as published, via PubMed.