Video Decision Aids Boost Advance Care Planning in Seniors with Advanced Kidney Disease
A new study published in JAMA Internal Medicine reveals that utilizing a video decision aid alongside patient-created video declarations significantly increases the documentation of advance care planning among older adults with advanced chronic kidney disease. The findings were presented to coincide with Kidney Week, the annual meeting of the American Society of Nephrology.
Evaluating Advance Care Planning Interventions
Researchers led by Dr. Angelo E. Volandes from Dartmouth Health in Lebanon, New Hampshire, conducted a multicenter, parallel-group, randomized clinical trial across 12 ambulatory clinics. The study aimed to evaluate whether standardized education via video, combined with personal video declarations detailing patient goals and values, could improve advance care planning paperwork in the electronic health record for individuals aged 65 years and older.
A total of 453 participants were enrolled in the trial. While 225 participants received usual medical care as a control group, 228 intervention participants watched a certified video decision aid outlining three treatment options for advanced chronic kidney disease. Following the video, these participants recorded a short video declaration stating their personal values and preferences, which was subsequently sent directly to their treating clinician.
Key Findings and Patient Preferences
The investigators observed notable differences between the two groups at the 12-month mark. Advance care planning documentation reached 56.6 percent in the intervention group compared to 40.0 percent in the control group. Furthermore, documented discussions concerning treatment options for kidney failure were higher among those who received the intervention, standing at 46.1 percent versus 31.6 percent.
The study also highlighted changes in patient certainty regarding their medical path. After viewing the educational material, fewer intervention participants reported feeling undecided about their treatment choices compared to the control group, with figures at 13.2 percent and 41.3 percent, respectively. Additionally, a greater proportion of participants in the intervention arm expressed a preference for conservative kidney management over more invasive interventions, at 50.7 percent compared to 31.8 percent.
Study Limitations and Next Steps
The study authors noted important limitations regarding the clinical implications of these results. They emphasized that further research is required to determine whether an increase in electronic health record documentation directly translates into goal-concordant care for patients as their disease progresses. However, the researchers concluded that pairing standardized video education with patient-authored preference statements serves as a feasible addition to routine clinical care for managing advanced chronic kidney disease.
