Branching-scenario games in acute end-of-life care education: cultural adaptation and health equity from a public health implementation perspective.

The quality and accessibility of end-of-life (EOL) care are sensitive indicators of health equity, yet these services remain profoundly unequal worldwide. The challenge is especially acute in emergency and critical care, where clinicians must reconcile time-pressured medical decisions with emotionally charged communication. Branching-scenario games, serious games built on clinical decision trees, have emerged as a promising educational tool for rehearsing such competencies in a safe, repeatable virtual environment. However, their effectiveness is not a matter of simple technology transfer: it depends heavily on cultural fit and on an explicit commitment to health equity. In this mini-review, we examine branching-scenario games in acute EOL care education through a public health implementation lens. We synthesise evidence on their value and limitations, review principles and practise of cultural adaptation, situate them within debates on health equity and barriers to equitable care, and consider how they might be scaled from discrete educational projects to system-level public health interventions. We then summarise academic controversies, identify research gaps, and outline future directions, including participatory design, mixed-methods evaluation, and AI-driven adaptive learning. We argue that, with rigorous cultural adaptation and equity-by-design, these games can evolve from a novel teaching technology into a lever for advancing equitable EOL care.