Cultural Adaptation and Pilot Implementation of Education in Palliative and End-of-Life Care for Emergency Physicians (EPEC-EM) for Emergency Medicine Practice in Japan

Abstract

Introduction:

Japan’s aging population has increased emergency presentations among patients near the end of life, yet formal palliative care training for emergency physicians remains limited. The U.S.-developed Education in Palliative and End-of-Life Care for Emergency Medicine (EPEC-EM) program offers structured education in communication and symptom management. We piloted a cultural adaptation of selected modules for the Japanese emergency care context.

Methodology:

A multidisciplinary Japan–United States team adapted three modules (Trajectories & Prognoses, Breaking Bad News, and Dyspnea Management) through an iterative process involving preliminary redesign, pilot delivery, and refinement across four online sessions.

Discussion:

Concepts such as goals-of-care discussions and communication around limiting resuscitation required clearer explanation for Japanese physicians. Iterative revisions improved clarity and cultural relevance.

Conclusion:

This pilot demonstrates the feasibility of culturally adapting EPEC-EM for Japan. The process provides a foundation for developing a tailored curriculum and informs future broader implementation.

Keywords

cultural adaptation emergency medicine end-of-life care palliative care training program

Get full access to this article

View all access options for this article.

References

1.Fire and Disaster Management Agency. Current status of emergency medical services in 2024. Available from: http://www.fdma.go.jp/publication/rescue/post-6.html [Last accessed: 7 September 2025 ].

2.Ministry of Health, Labor and Welfare. Vital statistics of Japan. Available from: http://www.mhlw.go.jp/toukei/list/81-1.html 2025 [Last accessed: 30 September 2025 ].

3. Noguchi

, Kaneko

, Hoshiyama

, et al. Status of cancer patient transported to critical care medical center and secondary emergency care center. Nihon Kyukyu Igakukai Zasshi 2018;29:1–11.

4. Ito

, Taguchi

, Inoue

, et al. About the present conditions and problems of the elderly patient first aid: Particularly the conveyance case from a nursing facility in the Kitakyushu City. J Jpn Soc Emerg Med 2016;19:7–12.

5. Wang

, Heidt

. Emergency department admission triggers for palliative consultation may decrease length of stay and costs. J Palliat Med 2021;24(4):554–560.

6. Mori

, Morita

. Advances in hospice and palliative care in Japan: A review paper. Korean J Hosp Palliat Care 2016;19(4):283–291.

7. Tanaka

, Kato

, Ito

, et al. Attitudes and barriers of physicians toward palliative care in critical care setting: Qualitative content analysis using open-ended data from nationwide self-administrated questionnaire survey in Japan. Palliat Care Res 2023;18(2):129–136.

8. Numata

, Fujitani

, Funakoshi

, et al. Differences in code status practice patterns among emergency clinicians working in Japan and the United States. Patient Educ Couns 2024;128:108368.

9.Northwestern University Center for Bioethics and Medical Humanities. EPEC-EM: Education in palliative and end-of-life care–emergency medicine. Available from: http://www.bioethics.northwestern.edu/programs/epec/curricula/emergency-medicine.html [Last accessed: 7 September 2025 ].

10.

10. Quest

, Emanuel

, Gisondi

, et al. Impact of the education in palliative and end-of-life care project on emergency medicine education and practice. J Pain Symptom Manage 2010;39(2):334–335.

11.

11. Gisondi

, Lu

, Yen

, et al. Adaptation of EPEC-EM™ curriculum in a residency with asynchronous learning. West J Emerg Med 2010;11:491–499.

12.

12. Numata

, Higuchi

, Hirose

, et al. Adapting palliative and end-of-life care training for emergency physicians in Japan: A modified grounded theory study. AEM Educ Train 2025;9(6):e70113.

13.

13. Ohtaki

, Ohtaki

, Fetters

. Doctor-patient communication: A comparison of the USA and Japan. Fam Pract 2003;20(3):276–282.

14.

14. Bernal

, Jiménez-Chafey

, Rodríguez

MMD

. Cultural adaptation of treatments: A resource for considering culture in evidence-based practice. Prof Psychol Res Pract 2009;40(4):361–368.

15.

15. Shimizu

, Hibino

, Biros

, et al. Emergency medicine in Japan: Past, present, and future. Int J Emerg Med 2021;14(1):2.

16.

16. Hibino

, Hori

. Emergency medicine in the US and the US model emergency medicine in Japan. J Jpn Assoc Acute Med 2010;21(12):925–934.

17.

17. Higashi

, Takaku

, Yamaoka

, et al. The dedicated emergency physician model of emergency care is associated with reduced pre-hospital transportation time: A retrospective study with a nationwide database in Japan. PLoS One 2019;14(4):e0215231.

18.

18. Guest

, Bunce

, Johnson

. How many interviews are enough? An experiment with data saturation and variability. Field Methods 2006;18(1):59–82.

19.

19. Makino

, Fujitani

, Twohig

, et al. End-of-life considerations in the ICU in Japan: Ethical and legal perspectives. J Intensive Care 2014;2(1):9.

20.

20. Yaguchi

, Truog

, Curtis

, et al. International differences in end-of-life attitudes in the intensive care unit: Results of a survey. Arch Intern Med 2005;165(17):1970–1975.

21.

21. Kite

, Wilkinson

. Beyond futility: To what extent is the concept of futility useful in clinical decision-making about CPR? Lancet Oncol 2002;3(10):638–642.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.02 MB

0.08 MB