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Review of medical care and care at the final stage of life

Think about medical care and care at the final stage of life (introduction of "Hello Notebook" about medical care and care)

Final update date December 17, 2020

"Medical care at the final stage of life" means

From August 2019, distribution locations have been expanded. For more information, please.

The video "How to use a notebook" has been released. For more information, please.

In recent years, due to the development of medical care, the number of cases where it is possible to extend the life even if recovery is not expected is increasing.

However, if you take steps to extend your life, you will continue to live in a state that is not preferred by some people, such as being connected to tubes and machines. For this reason, more and more people are thinking about what they want to do to live a fulfilling life until the end.

■Why do you think in advance?

At the end, there is a phase of making decisions about what you want and what you don't want about the medical and care you receive. Depending on the individual case, you may need to express your desire for treatment that includes what is called so-called life extension treatment, such as the use of tracheal intubation and respirators, tube feeding, and the need for gastric deafness.
However, when a decision is needed, it is not always possible to express your own intention. The condition at that time, such as deterioration of medical condition, dementia, and aging, is unclear.
Therefore, it is recommended that you consider and leave your wishes in advance.

■At medical and nursing care sites

The following situations often occur. You need to think in advance and share with anyone in the process of thinking.

  • When a patient who has been transported by emergency with a medical condition that is unlikely to recover is rescued, the family does not want it. The wishes of the individual and the wishes of the family do not match.
  • At the nursing care site, the person cannot confirm his / her intention due to dementia.
  • In a situation where the patient cannot express his / her intention, he / she visits life extension treatment and has different opinions within the family (cannot communicate with distant families).
  • There is no access and you cannot confirm your intention when you are transported by emergency.

■How do you think about it?

Advanced Care Planning ※Based on (ACP)'s idea, it is desirable to make a decision through discussions with healthcare professionals such as family doctor.
In the discussion, it is not just a choice of treatment method, but it is necessary to repeat the discussion based on the idea of what the person emphasizes at the end and the backbone of life and values.
In addition, it is recommended to discuss with trusted people such as families, share ideas, and promote the creation of relationships between families and guardians and medical and nursing care professionals.

Advanced Care Planning (ACP: Nicknamed "Life Conference")

This is a process in which family members, trusted people, and medical and nursing care workers discuss in advance what kind of medical and care they want in case of emergency.


In the final stage of life, medical care and care should be provided according to wishes, including the person's view of life and values.

'What is important'

  • The person is the subject.
  • Share the thoughts and values of the individual with family members, trusted people, and healthcare and nursing care workers.
  • Keep the contents of the discussion in the record.
  • Review regularly and discuss repeatedly


  • Situation (family structure, medical history, nursing care services, etc.)
  • Values (things that we value, things that we are worried about, etc.)
  • Intention (medical care and care desired, place to spend the last time, etc.)
  • People who want to talk with medical and nursing care workers instead of when they can no longer make decisions.

Yokohama-shi approach-"Hello notebook" about medical care-care-

In Yokohama City, we hold a study meeting consisting of multiple occupations such as healthcare professionals, care workers, lawyers, etc. so that each citizen can think about medical care and care at the final stage of life from a healthy state and express their wishes. And have been studying ways to raise awareness.
Based on the discussions at the study meeting, we created a "Hello Notebook for Medical Care" (PDF: 3,013KB) as an educational tool for citizens.

The video "How to use a notebook" has been released.

■What is the purpose of the notebook?

The purpose of this program is to give you a chance to think about medical care and care at the "final stage of life" in order to leave your thoughts. We also hope that it will help you to talk about your thoughts with trusted people such as family members and healthcare and nursing care workers.

■Contents and format

Assuming that you will not be cured and you will not be able to express your intention, we have prepared three questions in the middle. It is easy to answer by checking options.

On the spread side, three typical patterns of changes in physical functions until the end are introduced.

  • cancer
  • Systemic function lasts a relatively good period
  • One to two months before death, the condition worsens rapidly.
  • Prediction is relatively easy
  • Heart failure, respiratory failure (chronic disease)
  • The condition worsens calmly while repeating rapid deterioration and improvement due to the onset of infectious diseases.
  • It changes relatively rapidly just before death
  • Dementia, Neurology incurable disease and Aging
  • The whole body functions for a long time.
  • The overall decline continues, and the function declines until death.

■How to use

1. "Thinking about"

First, try to organize your thoughts while answering the questions.
When thinking, it is effective to look back on the questions you answered, regardless of the order of the questions.

2. "Let's talk."

If you look at your notebook and discuss your thoughts with those who are involved in medical care and care at the final stage of life.
This allows the person to be involved in the medical care and care desired by the person in the event of "what if". Also, discussions may deepen your thoughts.

3. "Re-shake"

Discussions, the passage of time, and changes in the situation may change your thoughts. If you change your mind, I'll try again. I'll try to discuss it again after I get it over.

■Form and Distribution Method

Compact size (9.5cm x 13cm) which is wide and thin and easy to carry.
We will distribute it as a set with the case of the medicine notebook (we will also give you an explanation flyer (PDF: 833KB).
Carrying your thoughts will lead to discussions with your GP or family pharmacy.

■Distribution Site

We started distribution in each ward Health and Welfare Center Elderly and Disabled Support Division, home medical care cooperation base, and community care plaza have started distribution.
It may be distributed at nearby pharmacies, medical institutions such as clinics.
※Please refer to the following list about pharmacy joining Yokohama-shi pharmacist society of each ward.


If your notebook is not a "will" or "advance instruction", there is no legal binding or enforcement at the emergency site.

About registration of trademark of notebook

The trademark "Hello Notebook", which Yokohama City had applied for to the Patent Office, was registered as a trademark on July 31, 2020.
The contents of the trademark registration are as follows.

■Registration of trademarks

Trademarks: Hello, my notebook
Items Contents
Trademarks (standard characters) Hello, my notebook
Division 16th notebook, notebook, card, printed matter
Trademark holders

6-50-10, Honcho, Naka-ku, Yokohama-shi, Kanagawa

Date of application October 25, 2019
Registration date July 31, 2020
registration number Registration No. 6275596

The trademark registration certificate can be downloaded here (PDF: 708KB).
※Address and Address and the city as of the date of application due to the relocation of the city's new city hall (full service started on June 29, 2020) with regard to the trademark owner's town.
 It's different. The JPF has applied for a change of registered name holder's display. The Address.
 Even if you go, it will not be changed to a new Address.

■Notes on registration of trademark

(1) The currently distributed "Hello Notebook" does not include the® mark (registered trademark mark). However, as described above,
   Because we perform trademark registration, we use name without notice in Motoichi and use different from creation intention.
   Please note that we can't.
(2) Medical Care Bureau Cancer and Disease Control Section if you have a request to use the name "What if you want to use the notebook" or to refer to this project.
   Please contact the home medical staff.
(3) If you notice the existence of a similar trademark, we will contact you for confirmation. In some cases, procedures for warnings and recommendations should be taken.
   I have to take it.

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Inquiries to this page

Medical Care Bureau Disease Control Department Cancer and Disease Control Division Home Health Care Section

Telephone: 045-671-244444

Telephone: 045-671-244444

Fax: 045-6644-3851

Email address: [email protected]

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