Profile
Kenji Numata
Throughout my career in emergency medicine, I have often had a conflict feeling of not being able to provide appropriate end-of-life care to patients at the end stage of life. By "inability to provide appropriate end- of-life care," instead of offering care that enhances the quality of life (QOL) for end-of-life patients, we sometimes administer burdensome treatments that may decrease their QOL, resulting in physical strain for the patients, which ironically increased workload of healthcare providers. Moreover, such treatments often involve high medical costs, which significantly gives an impact on the country’s finances as well as taxpayers.
I had an opportunity to learn about end-of-life care at Iizuka Hospital in Fukuoka, Japan, which greatly transformed my approach to patient care. Following that experience, I began organizing regular study sessions on end-of-life care, and I came to realize that many other physicians shared the same dilemma, convincing me that fundamental solutions are needed.
In the U.S, end-of-life care training courses designed to improve the QOL of terminal patients have been developed. I believe that introducing such courses in Japan, where the aging population is rapidly increasing, is crucial. I am currently working through my research to bring this course to Japan!
What do you hope to accomplish through your research?
What I hope to accomplish through my research is to enable emergency healthcare providers to deliver necessary and appropriate end-of-life care to terminal patients brought to the emergency department. The term "end-of-life" refers to the period when a person is believed to have less than a year to live due to incurable illness, and end-of- life care aims to respect the patients’ wishes and dignity, helping them live their remaining time peacefully while maintaining their QOL.
When terminal patients unexpectedly visit the emergency department, they are often unable to express their wishes due to deteriorated consciousness or worsening symptoms. As a result, they may receive invasive treatments tailored to the emergency situation, which might differ from the decisions they and their families would make under normal circumstances. For example, during the recent COVID-19 pandemic, emergency physicians saw numerous cases of terminal patients who were infected with COVID-19 and became critically ill. At that time, there were issues related to the allocation of medical resources, and physicians had to quickly and accurately determine whether invasive treatments, such as mechanical ventilation, would improve the patients' outcomes, highlighting the importance of end-of-life care.
Unexpected visits to the emergency department can sometimes prevent terminal patients from receiving the end-of- life care they desire. Therefore, it is crucial for emergency physicians to learn about and provide appropriate end-of- life care; however, opportunities to learn about such care in Japan are limited. As a result, there are cases where invasive treatments are initiated, and after seeing a patient sustained by life-support machines, the family may express their wish not to continue the treatment. This creates a situation where patients, their families, and even emergency healthcare providers suffer from the ethical and emotional burden of the situation. I designed this research out of a desire to resolve these issues.
What approach are you using to try to achieve this?
The Ministry of Health, Labour and Welfare in Japan defines the concept of "Advance Care Planning (ACP)" as the process of thinking ahead about the care patients want and discussing it with their family and medical team. However, in Japan, only 1.5% of people have had detailed conversations about ACP, leading to various challenges in emergency departments, as mentioned earlier (reference).Before I studied end-of-life care, I once provided all possible treatments for a critically ill terminal patient, but the patient eventually passed away. Although the family expressed their gratitude, one of them asked, "Wasn’t there something more we could have done?" This left me with a heavy emotional burden. I believe many emergency physicians have had similar experiences.
Increasing the prevalence of ACP is crucial for ensuring that patients and their families receive the care they want. However, there is a cultural tendency in Japan to avoid thinking about death. For instance, when I once asked my grandmother, "What would you like us to do if your health gets worse?" she cried and said it was bad luck to discuss such things. Raising the rate of ACP will take time, but without progress, Japan's rapidly aging population will only increase the burden on emergency physicians. Creating a system that allows appropriate end-of-life care to be provided in emergency departments is an urgent task.
As I was searching for a solution, I met Dr. Kei Ouchi, an emergency medicine specialist in the U.S. who is well- versed in end-of-life care research. After discussing my thoughts with him, he suggested introducing the "EPEC-EM" training course to Japan. Under Dr. Ouchi's guidance, I am currently working to adapt EPEC-EM with the goal of improving the knowledge and skills of Japanese emergency physicians in end-of-life care.
What is the research topic you will be conducting for this project?
The EPEC-EM (Education in Palliative & End-of-Life Care for Emergency Medicine) is a training course developed in the United States with the aim of providing emergency physicians with knowledge and skills in end-of-life care. To date, it has trained over 3,500 instructors, and more than 200,000 participants across 26 countries have completed the course under their guidance.
My goal is to adapt, implement, and promote EPEC-EM in Japan's healthcare system. Since December 2023, I have been conducting this research through the following approach:
First, with the permission of Dr. Tammie Quest, principal developer of EPEC-EM and a collaborator on this research (also my recommender), I will analyze the course content and instructional methods.
Next, to customize the program for the Japanese emergency care context, I will design a curriculum taking cultural and healthcare system differences into consideration. This requires identifying the challenges faced by Japanese emergency physicians. I have already published a paper on “Differences in Breaking Bad News between Japan and the United States,” which suggests significant communication differences between the two countries. Currently, I am using semi-structured interviews with Japanese emergency physicians to identify specific knowledge and skills needed.
Based on these findings, I plan to develop and implement a training course within the next two years and investigate its impact on clinical practice.
Why we need your support
The main reasons I am embarking on this crowdfunding journey are my strong desire to "reduce the number of patients unable to receive appropriate end-of-life care" and "address the struggles of emergency physicians." To achieve this goal, I have overcome many challenges on my path to pursuing research in the United States, a pioneer country in end-of-life care. I am determined to make this project a success and contribute to the healthcare system, patients, and physicians in Japan. Furthermore, this research will facilitate cultural exchange between Japan and the U.S. by allowing both countries to learn from each other about how to train clinicians to improve their end-of-life care skills in their own cultures.
Through this project, I have also had more opportunities to engage with people outside the medical field. When I explain the current state of end-of-life care in emergency departments, many respond with surprise, saying, "Really, is that what's happening?" Indeed, unless someone is a healthcare professional, they might not be aware of these issues in their everyday life. By sharing my research through academist, I hope to reach a wider audience, raise awareness, and receive feedback from various perspectives, which is why I decided to take on this challenge.
The support I receive will be used carefully for expenses necessary for my research activities, such as conference fees, journal submission fees, and personnel costs for the training courses I plan to hold in the future. I sincerely appreciate your support.
Recommender's comment
Shigeki Fujitani
Dr. Numata is an exceptionally skilled emergency physician with outstanding clinical expertise and a patient-centered approach. Academically, he has been very active, delivering numerous presentations at academic conferences and publishing a wide range of papers. His passion for end-of-life care and dedication to research will undoubtedly make significant contributions to the future of emergency medicine in Japan. Both as an individual and as a department chief, I wholeheartedly support his continued growth and strongly recommend him.
Tammie E Quest
Dr. Numata's project to introduce EPEC-EM in Japan paves the way for a new approach to end-of-life care in emergency medicine, and I strongly support its success. With over 20 years of experience as a leader in palliative care education within U.S. emergency medicine, I have mentored many physicians. I am confident that Dr. Numata will develop a new palliative care education program tailored to the Japanese healthcare setting, significantly improving the quality of emergency care in Japan. His efforts are of critical importance in Japan's aging society, and I wholeheartedly recommend him.
Kei Ouchi
I first met Dr. Numata in 2020, and since then, we have deepened our collaboration through monthly meetings. He is now actively engaging in research and course development under my guidance. His efforts align with my understanding of end-of-life care in Japan, making this a highly significant project. I am deeply impressed by Dr. Numata's passion and dedication to this initiative, and I strongly wish for the success of his project.
Hiraku Funakoshi
I strongly resonate with Dr. Numata’s work, as I personally recognize the importance of end-of-life care and palliative care in emergency departments. Having worked alongside Dr. Numata, I was deeply impressed by his dedication and commitment, both in his diligent work ethic and his current research endeavors. Together, we are currently developing a training course aimed at helping young physicians acquire the necessary communication skills in emergency care settings. Based on his past research and initiatives, this new course will be crucial for emergency medicine in Japan. I fully support Dr. Numata’s activities and wish him all the best!
Hideyuki Kashiwagi
I first met Dr. Numata in 2017 at St. Luke’s International University Graduate School of Public Health, and in 2018, he studied under me in the Department of Integrated Medicine and Palliative Care, where I serve as Director. I was deeply impressed by his enthusiasm and passion, and I now serve as an advisor for his project. His work addresses an extremely important topic for the future of healthcare. I sincerely ask for your support.
Project timeline
| Date | Plans |
|---|---|
| December 2023 | Begin semi-structured interviews with emergency physicians working in Japan |
| July 2024 | Begin research fellowship at Brigham and Women's Hospital |
| September 2024 | Analyze and write a paper based on the results of the semi-structured interviews |
| October 2024 | Attend the EPEC-EM course and begin translation |
| January 2025 | Conduct a trial of the Japanese version of EPEC-EM online and investigate changes in clinical practice |
| May 2025 | Present at The Society for Academic Emergency Medicine (Philadelphia) |
| July 2025 | Officially launch the Japanese version of EPEC-EM at St. Marianna University School of Medicine; consider regular sessions |
| October 2025 | Report findings at the 53rd Annual Meeting of the Japanese Association for Acute Medicine |
Pledge Rewards
I will send you a thank you message via email.
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scheduled date details
| return | scheduled date |
|---|---|
| お礼のメッセージ | February, 2025 |
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Your name will be listed in a research report that will be sent to all supporters.
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scheduled date details
| return | scheduled date |
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| お礼のメッセージ | February, 2025 |
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You are invited to an online science café about this research.
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scheduled date details
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| オンラインサイエンスカフェ | December, 2024 |
| お礼のメッセージ | February, 2025 |
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| お礼のメッセージ | February, 2025 |
| オンラインサイエンスカフェ | December, 2024 |
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Individual discussion / Thank you message / Your name is posted in the research report / Online Science Cafe / Your name is posted in the thesis acknowledgment.
scheduled date details
| return | scheduled date |
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| 個別ディスカッション | February, 2025 |
| お礼のメッセージ | February, 2025 |
| オンラインサイエンスカフェ | December, 2024 |
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Visiting lecture / Thank you message / Your name is posted in the research report / Online Science Cafe / Your name is posted in the thesis acknowledgment. / Individual discussion
scheduled date details
| return | scheduled date |
|---|---|
| お礼のメッセージ | February, 2025 |
| オンラインサイエンスカフェ | December, 2024 |
| 個別ディスカッション | February, 2025 |
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academist Prize 4th adopted
