背景及重要性：哀傷是自古以來全人類共同的經驗，是面對失落正常的自然反應。然而，約有7~20%的喪親者，因為失去重要他人的巨大衝擊，可能出現哀傷困難調適情形，導致生理、心理、社會或靈性等層面影響甚鉅，進而增加醫療資源的耗費。世界衛生組織已明確將哀傷歷程因應的陪伴支持，納入安寧緩和療護的照護之中，但現有的哀傷風險評估工具，題目敘述跨越死亡前後，未明定使用時機，無法符合當病人確診末期狀態時盡早評估。故發展臨床適用，且具多面向哀傷風險因子及保護因子之「哀傷風險評估量表」，有助於及早評估，以利適當提供關懷陪伴、強化自我調適能力、及早轉介相關資源之專業協助等，避免進展為哀傷困難調適。

研究目的：基於廣泛性文獻查證基礎及修正型德菲法共識決策程序，發展「哀傷風險評估量表」，並進行臨床小樣本前驅測試檢測信效度，作為輔助臨床實務之評估工具。

研究方法：本研究設計包含兩個階段，第一階段經系統性文獻回顧建構量表內容，並進行兩回合修正型德菲法(modified Delphi method)共識決策程序，邀請15位跨領域專業人員共同組成專家小組，包含安寧緩和療護醫護臨床專家、哀傷撫慰實務專業人員、社工師、臨床心理師及工具發展專家等跨領域專家，針對量表格式、選項計分方式、面向及題項的相關性、清晰性進行審查評核。第二階段為小樣本前驅測試，納入同意受試、接受安寧緩和療護癌症末期病人的重要他人30位，填寫「中文版預期性悲傷量表」及「哀傷風險評估量表」，並進行資料分析。研究者根據專家意見及資料分析結果進行量表發展之修訂，建構「哀傷風險評估量表」的專家內容效度、效標關聯效度及內在一致性信度。

研究結果：根據系統性文獻回顧結果，發展「哀傷風險評估量表」共22題包含三大面向及八個次面向，分別為內在風險因子9題（關係緊密程度2題、不安全依附型態4題、身心健康狀態3題）、外在風險因子8題（非預期之末期情境3題、社會支持4題、多重性失落與壓力1題）及保護因子5題（自我信念與意義感3題、因應能力2題），專家審查結果I-CVI= 0.93~1、S-CVI= 0.99~1，具有良好的專家內容效度。量表與「中文版預期性悲傷量表」效標關聯之同時效度rs= .327 (p= .078)，而整體內在一致性信度Cronbach’s  = .672，因涵蓋多面向評估及受限於少量樣本數。

結論與建議：「哀傷風險評估量表」具有良好的專家內容效度，然而，因前驅測試之小樣本數的限制，尚需更多的臨床試用和檢測，才能確保量表的信效度。但經本研究可得知受試者填答反應，與臨床適用性，可根據本研究哀傷風險評估的架構，建立臨床哀傷風險評估的作業標準，有助於臨床醫療人員盡早評估，以利即早介入，提供適切之哀傷撫慰，避免進展為哀傷困難調適的負向結果。建議未來研究，可擴大樣本數，納入住院、社區中各種不同疾病別，探討「哀傷風險評估量表」在不同環境、不同末期情境的實用性。

This study aimed to develop a Bereavement Risk Assessment Tool, which was named Bereavement Risk Assessment Scale. To assist clinical practice, when the patients suffer from terminal illnesses, the medical team members can do bereavement risk assessment in advance and provide appropriate individual intervention and support timely. The first stage of this study was a systematic literature review for the purpose of establishing domains and items of the Bereavement Risk Assessment Scale. The contents of the scale were then evaluated by fifteen interdisciplinary experts through two rounds of the modified Delphi method. The second stage of this study was a pilot study, which included thirty significant others of terminal cancer patients who received hospice palliative care from the medical center in southern Taiwan, to ensure clinical applicability and test the psychometric properties of the scale. As a result, the Bereavement Risk Assessment Scale indicated good expert content validity (I-CVI= 0.93~1, S-CVI= 0.99~1). However, due to the limitation of the small sample size of this pilot study, further research is needed to ensure reliability and validity in the future. Through this study, we have already known the subjects’ responses and clinical applicability. The clinical medical team can set up a bereavement risk assessment standard from the framework to provide bereavement care properly.

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