Video-Based Support Helps Older Adults Clarify Kidney Disease Treatment Preferences

Advanced chronic kidney disease (CKD) involves progressive loss of kidney function that can lead to kidney failure and difficult treatment decisions. For older adults, these decisions may include choosing between active kidney failure treatment and conservative kidney management. Clarifying their preferences helps guide advance care planning (ACP) documentation in the electronic health record. To support this process, a new study evaluated a video-based decision support approach and found that it increased ACP documentation in this patient group.

Researchers at Dartmouth Health (Lebanon, NH, USA) and colleagues evaluated a certified video decision aid for older adults with advanced CKD. The intervention paired standardized video education about treatment options with patient-created video declarations in which participants expressed their goals, values, and treatment preferences. These declarations were then sent to treating clinicians to support documentation and discussions about care.

The multicenter, parallel-group, randomized clinical trial enrolled adults aged 65 years and older with advanced CKD across 12 ambulatory clinics. The control group included 225 participants who received usual medical care. In the intervention group, 228 participants viewed a certified video decision aid depicting three treatment options for advanced CKD before creating their own video declarations.

At 12 months, ACP documentation in the electronic health record was higher in the intervention group, occurring in 56.6% of participants compared with 40.0% in the control group. Documented discussions of kidney failure treatment options were also more frequent with the intervention, at 46.1% versus 31.6%. After viewing the video, fewer intervention participants were undecided about treatment, at 13.2% versus 41.3%, while more preferred conservative kidney management, at 50.7% versus 31.8%.

The findings were published in JAMA Internal Medicine on October 22, 2026, to coincide with Kidney Week, the annual meeting of the American Society of Nephrology, held from October 21 to 25 in Denver. The study indicates that structured video education paired with patient-authored preference statements may be feasible in routine CKD care. Further work is needed to determine whether higher documentation rates lead to care that aligns with patient goals.

“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 authors wrote.

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