A Dartmouth Health-led clinical trial intended to help kidney disease patients better understand their treatment options showed success in helping patients understand what medicine can offer and helping physicians understand what matters most to the person receiving it. Lead study author Angelo E. Volandes, MD, MPH, chief research officer at Dartmouth Health, and his co-authors presented the findings of their Video Images about Decisions for Ethical Outcomes in Kidney Disease (VIDEO-KD) trial today as part of the American Society of Nephrology Kidney Week annual meeting; it was also published today in JAMA Internal Medicine.
The randomized controlled trial involved 453 adults age 65 or older at 12 outpatient clinics, with an average patient age of 79. Two-hundred twenty-eight randomized participants watched a video decision aid that explained their medical options. After watching the video, patients were invited to write or record an audio or video statement describing their values, wishes and treatment preferences. The declaration was sent to both the patient and the physician, making the patient’s personal wishes available for subsequent conversations and decisions. Patients could change their declaration at any point in the study.
Of the 253 patients offered the intervention, 207 completed a declaration, with 36 revising their declarations at least once during the trial. Within 12 months, advance care planning was documented in 56.6% of patients receiving the intervention, compared with 40% receiving usual care. Among these patients, the proportion undecided about their preferred kidney failure treatment fell from 39.6% before viewing to 13.2% immediately afterward; and 50.7% preferred conservative kidney management, compared with 31.8% of usual-care participants at enrollment.
“The video helps patients understand medicine, and the declaration helps medicine understand the patient,” Volandes said. “Our goal is not to persuade someone to choose dialysis or to decline it. Medicine’s goal is to help patients make informed decisions with their doctors and then give patients’ own words a place in that decision.”
The broader video-based approach is now being tested in the Advancing Ethical Goals in Society (AEGIS) trial, jointly led by Dartmouth Health, Tufts Medical Center and Northwell Health and funded by the National Institute on Aging. AEGIS will include more than 12,000 older adults and will examine whether patients receive care that reflects their goals and explore differences in the approach’s effectiveness across rural and urban America.
“A treatment recommendation tells us what might be medically possible,” Volandes said. “The patient tells us what makes it personally worthwhile. Better technology should make that conversation easier, not make the patient less necessary.”
About Dartmouth Health
Dartmouth Health, New Hampshire’s only academic health system and largest private employer, serves patients across New England. Dartmouth Health provides access to more than 2,300 providers in nearly every area of medicine, delivering care at its flagship hospital, Dartmouth Hitchcock Medical Center (DHMC) in Lebanon, NH. Its network of hospitals, outpatient centers, clinics and home care facilities, spans a broad geographical area. Year after year, DHMC is named the #1 hospital in New Hampshire by U.S. News & World Report, and is consistently recognized for high performance in numerous clinical specialties and procedures. Dartmouth Health includes Dartmouth Cancer Center, northern New England’s only National Cancer Institute-designated Comprehensive Cancer Centers and one of less than than 60 total nationally; Dartmouth Health Children’s, which includes the state’s only children’s hospital, the Golisano Children's Hospital at Dartmouth Health, and more than 20 locations around the region; eight member hospitals in Lebanon, Keene, Claremont, Hampstead, and New London, NH, and Windsor and Bennington, VT; Dartmouth Health Home Care; Dartmouth Health Connected Care Center for Telehealth, serving patients as far away as Texas; and more than 30 primary and multi-specialty clinics across New Hampshire and Vermont. Through its partnership with Dartmouth College, Dartmouth’s Geisel School of Medicine and the White River Junction VA Medical Center, Dartmouth Health trains nearly 400 medical residents and fellows annually and performs cutting-edge research and clinical trials with international impact. Dartmouth Health and its more than 16,000 employees are committed to serving the healthcare needs of everyone in the communities it serves and to providing every patient with exceptional, state-of-the-art, personalized care. Learn more at dartmouth-health.org.