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

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.