German-language adaptation of the Bereavement Risk Assessment Tool (BRAT): findings on the inter-rater reliability

Prolonged Grief Disorder (PGD) affects approximately 10% of the bereaved adults, with prevalence rates in Germany ranging between 4.7–5.4%. Early identification through pre-death risk assessment is crucial for optimal bereavement care, yet no validated German-language instrument exists. The Bereavement Risk Assessment Tool (BRAT) represents a promising solution but requires cultural adaptation and validation. The aim of this study was to adapt the BRAT for German-speaking countries and evaluate its inter-rater reliability among healthcare professionals in palliative care and hospice settings. A cross-sectional reliability study was conducted online. The BRAT was translated into German using forward and backward translation methodology, resulting in the Multiprofessioneller Fragebogen zur Trauerverarbeitung (MFT). Participants evaluated four case vignettes featuring 10 bereaved family members using the 40-item MFT. Inter-rater reliability was assessed using Gwet's AC and Krippendorff's α across multiple risk categorizations. A total of 55 healthcare professionals (78.2% female, M = 51.5 years) working in German palliative care and hospice settings were recruited. Participants included diverse professional groups: nursing staff, pastoral care workers, medical doctors, psychologists, and social workers. The MFT demonstrated good to excellent inter-rater reliability across most items. The majority of items showed good to almost perfect agreement between raters. Notable variations emerged between professional groups, with inter-rater reliability being influenced by the number of response categories used for risk assessment. The German adaptation represents a reliable tool for pre-death bereavement risk assessment in German-speaking healthcare settings. Profession-specific training programs may enhance consistency across occupational groups. Further validation studies examining predictive validity for PGD outcomes are warranted.