{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T21:03:31Z","timestamp":1778187811785,"version":"3.51.4"},"reference-count":35,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T00:00:00Z","timestamp":1765238400000},"content-version":"vor","delay-in-days":8,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["AEM Education and Training"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In Japan, the aging population has led to an increase in seriously ill patients requiring emergency care. Although palliative care training opportunities are limited in Japan, established programs exist in the United States (U.S.). To inform future adaptation of such programs for use in Japan, this study aims to identify barriers that emergency physicians (EPs) in Japan encounter when providing palliative care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This qualitative study explored the end\u2010of\u2010life care decision\u2010making processes of EPs in Japan. Semi\u2010structured interviews were conducted with board\u2010certified EPs using snowball sampling. Data were analyzed using a modified grounded theory approach, which was chosen for its ability to capture culturally nuanced decision\u2010making, emphasizing reflection, theoretical clarity, and practical applicability. Iterative coding was conducted to inductively generate concepts and develop a conceptual framework describing EPs' decision\u2010making processes. Data collection continued until theoretical saturation was achieved. Data were collected through online interviews conducted between January and August 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Thirteen board\u2010certified EPs in Japan completed interviews. Most participants were male (76.9%) and most were 11\u201315\u2009years after medical school graduation (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20097). Analysis identified 16 concepts illustrating a three\u2010phase decision\u2010making process: (1) deciding to accept the transfer of end\u2010of\u2010life patients, (2) building trust with patients and families and conducting an assessment, and (3) determining the treatment plan. Common challenges included\n                      <jats:italic>struggles with stalled interactions amid family distress<\/jats:italic>\n                      and\n                      <jats:italic>the dilemma of making decisions in the setting of clinical uncertainty<\/jats:italic>\n                      , reflecting the emotional and ethical complexity of providing end\u2010of\u2010life care in time\u2010pressured emergency settings.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study highlights the challenges EPs in Japan face when making urgent decisions with limited time and information while building trust with patients and families. These findings clarify the current barriers to integrating palliative and end\u2010of\u2010life care in emergency settings and provide a foundation for developing culturally adapted educational programs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/aet2.70113","type":"journal-article","created":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T03:55:10Z","timestamp":1765338910000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Adapting Palliative and End\u2010of\u2010Life Care Training for Emergency Physicians in Japan: A Modified Grounded Theory Study"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9813-5592","authenticated-orcid":false,"given":"Kenji","family":"Numata","sequence":"first","affiliation":[{"name":"Department of Emergency and Critical Care Medicine St. Marianna University  Kanagawa Japan"},{"name":"Department of Emergency Medicine Brigham and Women's Hospital  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masaya","family":"Higuchi","sequence":"additional","affiliation":[{"name":"Graduate School of Medicine Tohoku University  Sendai Japan"},{"name":"Division of Palliative Care and Geriatric Medicine Massachusetts General Hospital  Boston Massachusetts USA"},{"name":"Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasuhiko","family":"Hirose","sequence":"additional","affiliation":[{"name":"Nomura Research Institute, Ltd.  Tokyo Japan"},{"name":"Faculty of Business Administration Meisei University  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anita","family":"Chary","sequence":"additional","affiliation":[{"name":"Division of Health Services Research, Department of Medicine Baylor College of Medicine  Houston Texas USA"},{"name":"Center for Innovations in Quality, Effectiveness and Safety Michael E. DeBakey VA Medical Center  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tadayuki","family":"Hashimoto","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Brigham and Women's Hospital  Boston Massachusetts USA"},{"name":"Department of General Medicine Osaka Medical and Pharmaceutical University  Osaka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daisuke","family":"Kato","sequence":"additional","affiliation":[{"name":"Takemi Program in International Health Harvard T.H. Chan School of Public Health  Boston Massachusetts USA"},{"name":"Department of Family Medicine Mie University Graduate School of Medicine  Tsu Japan"},{"name":"Department of Social Preventive Medical Sciences Chiba University  Chiba Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5602-3717","authenticated-orcid":false,"given":"Shan W.","family":"Liu","sequence":"additional","affiliation":[{"name":"Division of Palliative Care and Geriatric Medicine Massachusetts General Hospital  Boston Massachusetts USA"},{"name":"Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tammie E.","family":"Quest","sequence":"additional","affiliation":[{"name":"Division of Palliative Medicine, Department of Family and Preventive Medicine Emory University Hospital  Atlanta Georgia USA"},{"name":"Department of Family and Preventive Medicine and Emergency Medicine Emory University Hospital  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joshua","family":"Hauser","sequence":"additional","affiliation":[{"name":"Department of Medicine, Feinberg School of Medicine Northwestern University  Chicago Illinois USA"},{"name":"Jesse Brown VA Medical Center  Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kirsten G.","family":"Engel","sequence":"additional","affiliation":[{"name":"Division of Palliative Care and Geriatric Medicine Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2723-4259","authenticated-orcid":false,"given":"Kei","family":"Ouchi","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Brigham and Women's Hospital  Boston Massachusetts USA"},{"name":"Harvard Medical School  Boston Massachusetts USA"},{"name":"Serious Illness Care Program Ariadne Labs  Boston Massachusetts USA"},{"name":"Department of Psychosocial Oncology and Palliative Care Dana\u2010Farber Cancer Institute  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,12,9]]},"reference":[{"key":"e_1_2_13_2_1","unstructured":"WHO \u201cAgeing and Health \u201daccessed August 3 2025 https:\/\/www.who.int\/news\u2010room\/fact\u2010sheets\/detail\/ageing\u2010and\u2010health#:~:text= to%2022."},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.3934\/publichealth.2023056"},{"key":"e_1_2_13_4_1","unstructured":"\u201cStatus of Population Aging and Implementation of Measures for an Aging Society \u201daccessed August 3 2025 https:\/\/www.shugiin.go.jp\/internet\/itdb_gian.nsf\/html\/gian\/gian_hokoku\/20230620koreigaiyo.pdf\/$File\/20230620koreigaiyo.pdf."},{"key":"e_1_2_13_5_1","unstructured":"\u201cReport on the Results of the FY 2022 Survey on Attitudes Toward Medical Care and Care in the Final Stages of Life \u201daccessed August 3 2025 https:\/\/www.mhlw.go.jp\/content\/10801000\/001235008.pdf."},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/jgf2.100"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.archger.2007.04.006"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/ams2.497"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2024.108368"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.2512\/jspm.18.129"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12245-020-00316-7"},{"key":"e_1_2_13_12_1","unstructured":"\u201cMedicine JAfA. 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