In this context, the patient and family members provide support to each other by discussing death, illness, and pain in a direct and open manner. In a family facing life-threatening illness, a closed awareness style would involve a great deal of secrecy. All conversations would have to direct attention away from the prospect of illness and death so as to keep the patient unaware. This would place a great deal of emotional strain on the family members, as they would carry the burden of their knowledge as well as the weight of the secret. The suspected awareness style would be equally difficult, as family members would be placed in the position of perhaps having to actively lie to the patient once they grew suspicious. This would make open and productive communication near-impossible, as there would be a lack of trust on both sides. The conversations in a family operating under a mutual pretense style would involve a complex system of rules and code words all designed to avoid...

There would be a great deal of pressure on all family members to not break the agreed-upon silence which could result in individuals retreating from the family unit or becoming angry. The conversations that take place amongst families engaging in the open awareness style are characterized by detailed discussions about the illness, death, and the emotions surrounding these pivotal events. Although the family members and the patient may be just as fearful or upset about death as those families who utilize the other styles of communication, the open awareness style allows for a greater level of mutual support. These awareness styles may change over the course of an illness as the patient and his or her family receive more details about the prognosis from health care providers.
References

DeSpelder, L.A. & Strickland, A.L. (2008). The last dance: Encountering death and dying. New York, NY: McGraw-Hill.