Video Decision Support and Advance Care Planning in Older Adults With Advanced Kidney Disease: The VIDEO-KD Randomized Clinical Trial

Importance: 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.

Objective

To determine whether a video decision aid about treatment options for advanced CKD, combined with patient-created video declarations, increases ACP documentation among older adults with advanced CKD. Design, setting, and participants: This multicenter, parallel-group randomized clinical trial was conducted at 12 ambulatory clinics from June 2021 to March 2025, with 12-month follow-up. Participants were adults 65 years or older with advanced CKD. Outcome assessors were masked to group assignment. Data were analyzed in April 2026.