Adapting Palliative and End-of-Life Care Training for Emergency Physicians in Japan: A Modified Grounded Theory Study

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.

This qualitative study explored the end-of-life care decision-making processes of EPs in Japan. Semi-structured interviews were conducted with board-certified EPs using snowball sampling. Data were analyzed using a modified grounded theory approach, which was chosen for its ability to capture culturally nuanced decision-making, emphasizing reflection, theoretical clarity, and practical applicability. Iterative coding was conducted to inductively generate concepts and develop a conceptual framework describing EPs' decision-making processes. Data collection continued until theoretical saturation was achieved. Data were collected through online interviews conducted between January and August 2024.

Thirteen board-certified EPs in Japan completed interviews. Most participants were male (76.9%) and most were 11-15 years after medical school graduation (n = 7). Analysis identified 16 concepts illustrating a three-phase decision-making process: (1) deciding to accept the transfer of end-of-life patients, (2) building trust with patients and families and conducting an assessment, and (3) determining the treatment plan. Common challenges included struggles with stalled interactions amid family distress and the dilemma of making decisions in the setting of clinical uncertainty, reflecting the emotional and ethical complexity of providing end-of-life care in time-pressured emergency settings.

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-of-life care in emergency settings and provide a foundation for developing culturally adapted educational programs.