Kidney Week

Abstract: TH-PO1230

Effect of a Video Decision Aid and Patient-Created Video Declarations on Advance Care Planning Documentation Among Older Adults with Advanced CKD

Session Information

• Late-Breaking Research Posters
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2202 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Volandes, Angelo E., Dartmouth Health, Lebanon, New Hampshire, United States

Angelo E. Volandes, MD, MPH

• Lakin, Joshua R., Dana-Farber Cancer Institute, Boston, Massachusetts, United States

Joshua R. Lakin, MD

• Chang, Yuchiao, Massachusetts General Hospital, Boston, Massachusetts, United States

Yuchiao Chang, PhD

• Lindvall, Charlotta, Dana-Farber Cancer Institute, Boston, Massachusetts, United States

Charlotta Lindvall, MD, PhD

• Quintiliani, Lisa M., Tufts Medical Center, Boston, Massachusetts, United States

Lisa M. Quintiliani, PhD, RD

• Lundquist, Andrew L., Massachusetts General Hospital, Boston, Massachusetts, United States

Andrew L. Lundquist, MD, PhD

• Liu, Annie, Dana-Farber Cancer Institute, Boston, Massachusetts, United States

Annie Liu, DO, MS, MPH

• Kurella Tamura, Manjula, VA Palo Alto Health Care System, Palo Alto, California, United States

Manjula Kurella Tamura, MD, MPH

• Unruh, Mark L., University of New Mexico Consortium of the Americas for Interdisciplinary Science, Albuquerque, New Mexico, United States

Mark L. Unruh, MD, MS, FASN

• Wong, Susan P.Y., University of Washington, Seattle, Washington, United States

Susan P.Y. Wong, MD, MS, FASN

• Davis, Aretha Delight, ACP Decisions, Waban, Massachusetts, United States

Aretha Delight Davis, MD, JD

• Garde, Cynthia, ACP Decisions, Waban, Massachusetts, United States

Cynthia Garde, MS, MBA

• Henault, Lori, Dartmouth Health, Lebanon, New Hampshire, United States

Lori Henault, MPH

• Samarakoon, Sajeewani, Massachusetts General Hospital, Boston, Massachusetts, United States

Sajeewani Samarakoon, PhD, MPH

• Hanchate, Amresh D., Wake Forest University, Winston-Salem, North Carolina, United States

Amresh D. Hanchate, PhD

• Mandel, Ernest I., Brigham and Women's Hospital, Boston, Massachusetts, United States

Ernest I. Mandel, MD, MS, FASN

• Green, Jamie Alton, Geisinger Health, Danville, Pennsylvania, United States

Jamie Alton Green, MD, MS

• Lawson, Kyla, Geisinger Health, Danville, Pennsylvania, United States

Kyla Lawson

• Randa, Seth, University of California San Francisco School of Medicine, San Francisco, California, United States

Seth Randa

• Paasche-Orlow, Michael K., Tufts Medical Center, Boston, Massachusetts, United States

Michael K. Paasche-Orlow, MD, MA, MPH

Background

Older adults with advanced chronic kidney disease (CKD) face consequential decisions about whether to initiate dialysis, yet advance care planning (ACP), the communication that prepares patients for such decisions, is documented infrequently in ambulatory settings.

Methods

VIDEO KD is a multicenter, parallel-group randomized clinical trial at 12 ambulatory clinics. Participants were adults aged 65 years or older with advanced CKD. Intervention participants viewed a certified video decision aid depicting three treatment options for advanced CKD (hemodialysis, peritoneal dialysis, and conservative kidney management), then created recorded a statement of goals, values, and treatment preferences in video, audio, or written format, that was sent to their treating nephrologist. Control participants received usual nephrology care. The primary outcome was ACP documentation in the electronic health record within 12 months of enrollment or death, whichever came sooner. Documentation was ascertained by validated natural language processing assisted human adjudication. Pre-specified secondary outcomes included documented discussion of kidney failure treatment options and stated treatment preferences.

Results

A total of 453 patients were included (228 intervention, 225 control; mean [SD] age, 78.8 [6.4] years; 190 [41.9%] women; 38 [8.4%] Black; 35 [7.7%] Hispanic). At 12 months, ACP documentation was higher in the intervention group than the control group (56.6% vs 40.0%; rate difference (RD), 16.6% (95% CI, 7.5% - 25.7%); P<.001), as was documented discussion of kidney failure treatment options (46.1% vs 31.6%; rate difference (RD), 14.5% (95% CI, 5.6% - 23.4%); P=.002). After viewing the video, fewer intervention participants than controls at enrollment were undecided about treatment (13.2% vs 41.3%), and more preferred conservative kidney management (50.7% vs 31.8%; P < .001 for the overall distribution).

Conclusion

Among older adults with advanced CKD, a video decision aid increased ACP documentation and reduced the proportion of patients who were undecided about treatment.

Acknowledgment

This study was supported by grant R01AG066892 from the National Institute on Aging, National Institutes of Health.

Funding

• Other NIH Support