Video Decision Support and Advance Care Planning in Older Adults With Advanced Kidney Disease: The VIDEO-KD Randomized Clinical Trial.
16 affiliations
- 1Department of Medicine, Dartmouth Health, Lebanon, New Hampshire.
- 2Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
- 3Department of Supportive Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
- 4Harvard Medical School, Boston, Massachusetts.
- 5Department of Medicine, Massachusetts General Hospital, Boston.
- 6Department of Medicine, Tufts Medical Center, Boston, Massachusetts.
- 7Division of Nephrology, Brigham and Women's Hospital, Boston, Massachusetts.
- 8Geriatric Research and Education Clinical Center, VA Palo Alto Health Care System, Palo Alto, California.
- 9Department of Medicine, Stanford University School of Medicine, Palo Alto, California.
- 10Division of Nephrology, University of New Mexico, Albuquerque.
- 11Division of Nephrology, Department of Medicine, University of Washington School of Medicine, Seattle.
- 12VA Puget Sound Health Care System, Seattle, Washington.
- 13ACP Decisions, Waban, Massachusetts.
- 14Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
- 15Department of Population Health Sciences, Center for Kidney Health Research, Geisinger, Danville, Pennsylvania.
- 16University of California at San Francisco Medical School, San Francisco.
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.
Related
- Clinical Decision Support for Fall Prevention in Primary Care : The eSTEPS Cluster Randomized Clinical Trial
- Generative AI-enabled clinical decision support system in primary care: a pragmatic, cluster-randomized trial
- A Transparent Rule-Based Decision-Support Prototype for Diabetic Menu Planning and Meal-Combination Optimization: Development and Computational Evaluation
- Shared Decision-Making and Decision Support in Advanced Chronic Kidney Disease: A Systematic Review of Models, Treatment Pathways, and Patient-Centered Outcomes
- Decision-support modelling for liver paired exchange integrating clinical thresholds and operational feasibility
BibTeX
@article{volandes2026video,
title = {{Video Decision Support and Advance Care Planning in Older Adults With Advanced Kidney Disease: The VIDEO-KD Randomized Clinical Trial.}},
author = {Angelo E Volandes and Joshua R Lakin and Yuchiao Chang and Charlotta Lindvall and Lisa M Quintiliani and Andrew L Lundquist and Annie Liu and Manjula Kurella Tamura and Mark Unruh and Susan P Y Wong and Aretha Delight Davis and Cynthia Garde and Lori Henault and Upeka Samarakoon and Amresh Hanchate and Ernest Mandel and Jamie A Green and Kyla Lawson and Seth N Randa and Michael K Paasche-Orlow},
journal = {JAMA internal medicine},
year = {2026},
month = oct,
doi = {10.1001/jamainternmed.2026.5989},
url = {https://europepmc.org/article/MED/42911803},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Video Decision Support and Advance Care Planning in Older Adults With Advanced Kidney Disease: The VIDEO-KD Randomized Clinical Trial.
AU - Angelo E Volandes
AU - Joshua R Lakin
AU - Yuchiao Chang
AU - Charlotta Lindvall
AU - Lisa M Quintiliani
AU - Andrew L Lundquist
AU - Annie Liu
AU - Manjula Kurella Tamura
AU - Mark Unruh
AU - Susan P Y Wong
AU - Aretha Delight Davis
AU - Cynthia Garde
AU - Lori Henault
AU - Upeka Samarakoon
AU - Amresh Hanchate
AU - Ernest Mandel
AU - Jamie A Green
AU - Kyla Lawson
AU - Seth N Randa
AU - Michael K Paasche-Orlow
PY - 2026
DA - 2026/10/22
JO - JAMA internal medicine
DO - 10.1001/jamainternmed.2026.5989
UR - https://europepmc.org/article/MED/42911803
AB - 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.
SN - 2168-6106
SN - 2168-6114
ER -