In this chapter we use a framework that describes how communication is modulated by social characteristics of the participants, limitations in memory, and cognitive processes. Because individuals have different cognitive processes, participants understand similar information in distinct ways. Social characteristics of the participants—such as hierarchical position, professional background, age, gender—will influence the amount, type, and quality of information sharing and understanding. Families’ and patients’ ability to understand and process complex information about diagnosis, treatments, and prognosis is limited by memory capacity. We discuss formal and informal communication encounters in the intensive care unit (ICU), such as rounds, family meetings, and bedside updates, and propose six strategies based on this framework to improve the quality of communication: (1) increase medical literacy of patients and families; (2) consider the use default options and make recommendations when medically appropriate; (3) explore and validate patients’ and families’ concerns; (4) train emotional self-awareness; (5) avoid conflicting information; and (6) use strategies to mitigate implicit biases in communication.