Nephrology · 2 h ago
Video decision aid increases advance care planning documentation in advanced CKD
In a 12-clinic randomized trial of 453 adults aged 65 years or older with advanced chronic kidney disease, a video decision aid plus a patient-created declaration increased electronic health record documentation of advance care planning over 12 months. The intervention also increased documented discussion of kidney failure treatment options and reduced the proportion of patients who were undecided about treatment.
- ACP documentation was 56.6% with the intervention versus 40.0% with usual care.
- Treatment-option discussions were documented more often in the intervention group.
- Fewer intervention participants were undecided about kidney failure treatment.
Older adults with advanced chronic kidney disease (CKD) face decisions about dialysis or conservative kidney management, but advance care planning (ACP) is often not documented in ambulatory care. This multicenter, parallel-group randomized trial enrolled 453 adults aged 65 years or older at 12 clinics from June 2021 to March 2025. The intervention combined a video explaining hemodialysis, peritoneal dialysis and conservative kidney management with a patient-created declaration of goals and treatment preferences sent to the treating clinician; controls received usual care. The primary outcome was ACP documentation in the electronic health record within 12 months or before death. Assessors were masked to group assignment.
ACP documentation was recorded for 56.6% of intervention participants and 40.0% of controls, a rate difference of 16.6 percentage points (95% CI, 7.5-25.7; P<.001). Documented discussion of kidney failure treatment options was also more frequent with the intervention (46.1% vs 31.6%; difference, 14.5 points; 95% CI, 5.6-23.4; P=.001). After viewing the video, 13.2% of intervention participants were undecided about treatment, compared with 41.3% of controls; conservative kidney management was preferred by 50.7% and 31.8%, respectively.
The findings support this approach as a way to increase ACP documentation and treatment-option discussions in older adults with advanced CKD. The trial did not establish whether the intervention improves decision quality, aligns eventual treatment with preferences, or affects clinical outcomes; follow-up was 12 months and the study population was predominantly White.
In practice
For adults aged 65 years or older with advanced CKD, a video decision aid covering dialysis and conservative kidney management, paired with a patient-created statement of goals and preferences, increased ACP documentation and recorded treatment-option discussions over 12 months compared with usual care. These results support the intervention as a communication and documentation strategy in settings similar to the participating ambulatory clinics. The trial does not show that it improves decision quality, ensures treatment is concordant with preferences, or changes health outcomes, so it does not establish that the intervention should alter treatment choices.
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JAMA Internal Medicine: Video Decision Support and Advance Care Planning in Older Adults With Advanced Kidney Disease ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.