Among older adults with advanced chronic kidney disease, a 12-minute certified video decision aid paired with patient-recorded health declarations significantly increased advance care planning documentation at 12 months, according to the VIDEO-KD trial published in JAMA Internal Medicine.
For older patients facing late-stage kidney decline, treatment choices often crystallize during acute hospital emergencies rather than through deliberate, unhurried planning. Over 130,000 individuals start dialysis annually in the U.S. at a median age of 65, yet many patients lack documented discussions regarding their goals, values, or alternatives despite repeated contact with medical providers.
To test whether structured digital tools can bridge this communication gap, researchers conducted a multicenter, parallel-group, randomized clinical trial across 12 ambulatory clinics from June 2021 to March 2025. The study enrolled 453 adults aged 65 and older with an estimated glomerular filtration rate of 30 mL/min/1.73 m2 or less, placing them at high risk for progression to kidney failure.
Trial Results and Documentation Rates at Twelve Months
The trial split participants into two parallel tracks: 225 control participants received routine medical care, while 228 intervention participants viewed a certified video decision aid depicting three treatment options for advanced chronic kidney disease—hemodialysis, peritoneal dialysis, and conservative kidney management.
The study included a total of 453 patients, comprising 228 intervention individuals and 225 control individuals. The mean age of the participants was 78.8 years with a standard deviation of 6.4 years, and 190 of the patients were women, representing 41.9% of the cohort. The racial and ethnic breakdown of the participants included 4 American Indian or Alaska Native individuals at 1.1%, 8 Asian individuals at 1.8%, 38 Black individuals at 8.4%, 35 Hispanic or Latino individuals at 7.7%, 3 Native Hawaiian or other Pacific Islander individuals at 0.7%, and 375 White individuals at 82.8%.
After viewing the narration, which was delivered at a fifth-grade reading level in English or Spanish, 90.8% of intervention participants recorded a personal health declaration via video, audio, or text. That statement went to their treating clinician. By the 12-month mark, the results showed a measurable divergence in medical records between the two groups.
| Clinical Measure | Intervention Group | Control Group |
|---|---|---|
| Advance care planning documentation at 12 months | 56.6% | 40.0% |
| Documented discussion of kidney failure treatment options | 46.1% | 31.6% |
| Participants undecided about treatment post-video | 13.2% | 41.3% |
| Preference for conservative kidney management | 50.7% | 31.8% |
Dartmouth Health Findings Presented at ASN Kidney Week
The findings were presented at the American Society of Nephrology Kidney Week annual meeting held in Denver from October 21 to 25, and simultaneously published in JAMA Internal Medicine. Angelo E. Volandes, MD, MPH, of Dartmouth Health in Lebanon, New Hampshire, and colleagues conducted the study.
The idea behind the video approach is simple: the video helps patients understand medicine; the declaration helps medicine understand the patient.
Angelo E. Volandes, MD, MPH, Dartmouth Health
Volandes emphasized that the intervention aimed to foster deliberation rather than steer patients toward any single outcome. Indecision dropped sharply after viewing the video materials, falling from 39.6% at baseline down to 13.2% post-video among intervention participants.
My hope is that doctors use these tools to strengthen shared decision-making, not to replace the conversation.
Angelo E. Volandes, MD, MPH, Dartmouth Health
Barriers such as limited appointment time, provider discomfort with prognosis discussions, and a lack of standardized support tools often leave patients navigating irreversible choices by default rather than by informed choice during hospital admissions. The trial authors noted that while documentation increased, future research must determine whether these records directly translate into goal-concordant care during later stages of illness.
Demographic Limits and Next Steps in Renal Care
Study authors acknowledged specific demographic limitations in the participant cohort. The trial relied primarily on academic-affiliated clinics, meaning the outcomes may not translate directly to community or rural health settings. Additionally, the study population was predominantly white at 82.8%, with Black participants making up 8.4% of the total cohort.
Patients must retain their moral agency — the authority to weigh medical advice against their own goals, values, and understanding of a worthwhile life.
Angelo E. Volandes, MD, MPH, Dartmouth Health
