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A 12-clinic randomized trial found that older adults with advanced chronic kidney disease who used a video decision aid and recorded their preferences had more advance care planning documented at 12 months than those receiving usual care. The study did not determine whether the additional documentation led to care that matched patients’ goals.
A randomized trial at 12 clinics found that a video decision aid paired with patient-recorded statements was associated with more advance care planning documentation among adults aged 65 and older with advanced chronic kidney disease (CKD). At 12 months, documentation was recorded for 56.6% of participants who received the intervention, compared with 40.0% of those receiving usual care, according to a study published in JAMA Internal Medicine.
The trial included 453 participants: 228 assigned to the intervention and 225 to the control group. Participants in the intervention group watched a certified video describing three treatment options for advanced CKD, then made a video declaration of their goals, values and treatment preferences. That recording was sent to their treating clinician. The control group received usual medical care.
At 12 months, clinicians had documented a discussion of kidney failure treatment options for 46.1% of the intervention group, compared with 31.6% of the control group. 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% of the intervention group and 31.8% of the control group, the report said.
The study was led by Angelo E. Volandes of Dartmouth Health in Lebanon, New Hampshire, and colleagues. It was published to coincide with Kidney Week, the American Society of Nephrology’s annual meeting held Oct. 21–25 in Denver. The article is titled “Video Decision Support and Advance Care Planning in Older Adults With Advanced Kidney Disease.”
More Preferences Reached the Medical Record
Advance care planning can give patients and clinicians a record of a person’s goals and treatment preferences as serious illness progresses. The trial’s results suggest that standardized video information plus a patient-authored statement may help prompt conversations and make preferences easier to document during routine care for advanced CKD.
The measured outcomes were documentation and stated treatment preferences, not whether patients later received care consistent with those preferences. The authors said further research is needed to determine whether increased documentation translates into goal-concordant care. The findings therefore support the intervention as a possible way to improve planning records, rather than establishing an effect on later treatment or health outcomes.
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How the Kidney Care Trial Worked
The research was a multicenter, parallel-group randomized clinical trial conducted in 12 ambulatory clinics. Adults aged 65 or older with advanced CKD were assigned either to usual care or to an intervention combining a certified educational video with a personal video declaration sent to the patient’s clinician. The comparison provides evidence about the intervention in the participating clinics, while the report does not establish how it would perform in every care setting.
Advanced CKD can involve decisions about treatment options as kidney failure approaches. The video presented three options, but the supplied report does not name them individually. The study focused on whether the combined intervention affected advance care planning records and discussions; it did not test the video aid separately from the patient-recorded statement.
“Further research is needed to determine whether increased documentation translates into goal-concordant care.”
— The study authors
Whether Later Care Matches Preferences
The report does not say whether the higher documentation rate led to treatment that matched patients’ stated goals, or whether the intervention changed health outcomes. It also does not provide details here on how long the video intervention took, how often participants completed the declaration, or whether the results differed across patient groups or clinics.
Because the intervention combined a decision aid with a recorded statement, the available results cannot identify which component contributed more to the observed differences. The study took place in 12 ambulatory clinics; the supplied material does not establish whether the findings would be similar in other settings or among younger people with CKD.
Further Testing of Patient Outcomes
The authors call for further research to determine whether more complete advance care planning records lead to care that reflects patients’ goals. The supplied report does not identify a planned follow-up study or a timetable for additional results. For now, the trial provides a 12-month comparison of documentation, treatment-option discussions and stated preferences between the intervention and usual-care groups.
Key Questions
What did the video decision aid include?
It described three treatment options for advanced CKD. The report does not name those options individually.
How many people took part?
The trial included 453 adults aged 65 and older with advanced CKD: 228 in the intervention group and 225 receiving usual care.
What was the difference in advance care planning documentation?
At 12 months, documentation was recorded for 56.6% of the intervention group and 40.0% of the control group.
Did the study show that patients received care matching their preferences?
No. The reported outcomes included documentation, treatment discussions and stated preferences. The authors said further research is needed to determine whether increased documentation leads to goal-concordant care.
Source: medicalxpress.com
