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

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. 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. 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. 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.