Video Decision Aid Boosts Advance Care Planning in Late-Stage Kidney Disease

DENVER — For older patients with advanced chronic kidney disease (CKD), a video decision support tool increased advance care planning (ACP) documentation and helped with treatment decisions, the randomized VIDEO-KD trial showed.

Among 453 patients ages 65 and older, ACP documentation was recorded for 56.6% of those in the intervention group, who watched a certified video decision aid on treatment options and created personal health declarations, compared with 40% of those in the usual care group at 12 months (P<0.001).

Intervention participants were also significantly more likely to have a documented discussion of kidney failure treatment options versus control patients (46.1% vs 31.6%, P=0.001), reported Angelo E. Volandes, MD, MPH, of Dartmouth Health in Lebanon, New Hampshire, and colleagues.

These findings were presented at the American Society of Nephrology Kidney Week annual meeting and simultaneously published in JAMA Internal Medicine.

“The idea behind the video approach is simple: the video helps patients understand medicine; the declaration helps medicine understand the patient,” Volandes told MedPage Today.

“My hope is that doctors use these tools to strengthen shared decision-making, not to replace the conversation,” he said. “The goal is not to persuade someone to choose dialysis or to decline it; it is to help them make an informed decision with their clinician that reflects what matters most to that person.”

Over 130,000 patients initiate dialysis annually in the U.S., at a median age of 65. “Despite repeated contact with clinicians, many patients lack documented discussions of goals or treatment alternatives,” the researchers wrote.

“Barriers include limited time, discomfort with prognosis, and the lack of structured tools to support these discussions,” they noted. Without such guidance, patients often start dialysis “by default rather than by informed choice” during acute hospitalizations.

“Patients must retain their moral agency — the authority to weigh medical advice against their own goals, values, and understanding of a worthwhile life,” Volandes urged. “Medicine is very good at recording what is wrong with a patient; we need to be just as good at preserving what matters to them.”

The parallel-group VIDEO-KD trial took place across 12 ambulatory clinics from June 2021 to March 2025, enrolling 228 intervention and 225 control participants (mean age 78.8 years; 41.9% women). All patients had an estimated glomerular filtration rate of 30 mL/min/1.73 m² or less, putting them at high risk for progression to kidney failure.

Intervention participants watched a 12-minute certified video decision aid depicting hemodialysis, peritoneal dialysis, and conservative kidney management, using fifth grade reading-level narration in English or Spanish. Afterward, 90.8% of participants created a recorded statement of personal goals and preferences via video, audio, or text — sent directly to their treating clinician.

After viewing the video, indecision dropped substantially: the proportion of intervention participants who were undecided fell from 39.6% at baseline to 13.2% post-video (compared with 41.3% undecided in the control group at enrollment). Additionally, 50.7% of intervention participants expressed a preference for conservative kidney management compared with 31.8% of controls (P<0.001 for the overall distribution).

“I was struck by the reduction in indecision,” Volandes noted. “What encouraged me was not a preference for any particular treatment, but patients’ willingness to consider their choices and tell us, in their own words, what mattered to them.”

Because the trial primarily recruited from academic-affiliated clinics, the authors noted that the findings may not generalize to community or rural settings. Furthermore, the cohort was predominantly white (82.8%), with Black participants representing 8.4% of the population, limiting generalizability to broader patient demographics.