{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T14:12:25Z","timestamp":1785420745295,"version":"3.56.0"},"reference-count":21,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Palliative Medicine"],"published-print":{"date-parts":[[2026,8,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Japan\u2019s 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methodology:<\/jats:title>\n                    <jats:p>A multidisciplinary Japan\u2013United States team adapted three modules (Trajectories &amp; Prognoses, Breaking Bad News, and Dyspnea Management) through an iterative process involving preliminary redesign, pilot delivery, and refinement across four online sessions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10966218261449538","type":"journal-article","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T09:27:42Z","timestamp":1778146062000},"page":"1123-1130","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["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"],"prefix":"10.1177","volume":"29","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\u2019s Hospital, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"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":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideyuki","family":"Kashiwagi","sequence":"additional","affiliation":[{"name":"Department of Transitional and Palliative Care, Iizuka Hospital, Iizuka, Fukuoka, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunsuke","family":"Kosugi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Iizuka Memorial Hospital, Iizuka, Fukuoka, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"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":[{"vocabulary":"crossref","role":"author"}]},{"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":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsten G.","family":"Engel","sequence":"additional","affiliation":[{"name":"Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kei","family":"Ouchi","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA."},{"name":"Harvard Medical School, Boston, Massachusetts, USA."},{"name":"Serious Illness Care Program, Ariadne Labs, Boston, Massachusetts, USA."},{"name":"Department of Supportive Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,5,7]]},"reference":[{"key":"e_1_3_3_2_1","unstructured":"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: 7September2025]."},{"key":"e_1_3_3_3_1","unstructured":"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: 30September2025]."},{"key":"e_1_3_3_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/jja2.12272"},{"key":"e_1_3_3_5_1","first-page":"7","article-title":"About the present conditions and problems of the elderly patient first aid: Particularly the conveyance case from a nursing facility in the Kitakyushu City","volume":"19","author":"Ito S","year":"2016","unstructured":"4.Ito S, , Taguchi K, , Inoue M, 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. 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