many factors in coping with the realizations, responsibilities, and constraints. important factors include the following: the genetic make-up, personality, life experience, physical, psychological, social, financial, religious, and spiritual resources; the type, degree, and duration of the disease, the consequences and side effects of treatment, the quality of medical treatment and care, the material surroundings (i.e. furnishings of the apartment, clinic, home); and the expectations, norms, and behavior of relatives, carers, doctors and the public. according to engelke, the complexity of dying and the uniqueness of each dying person creates guidelines for communication with dying people. awareness along with medical professionals and relatives, sociologists and psychologists also engage in the question of whether it is ethical to inform terminally ill patients of the infaust prognosis, or the uncertain diagnosis. in 1965, the sociologists barney g. glaser and anselm strauss published the results of empirical studies where they derived four different types of awareness of dying patients: closed awareness, suspected awareness, mutual pretense awareness, and open awareness. in closed awareness, only relatives, caregivers, and medical professionals recognize the patient's condition; the patient themselves does not recognize his dying. in suspected awareness, the patient suspects what those around him know, but they are not told by relatives of medical professionals. in mutual pretense awareness, all participants know about that the person is dying, but they behave as if they did not know. in open awareness, all participants behave according to their knowledge. the hospice movement in the united kingdom in particular has since advocated for open, truthful and trustful interaction. the situation does not become easier for all involved if difficult conversations are avoided; rather it intensifies and possibly leads to a disturbed relationship of trust between people, which makes further treatment more difficult or impossible.