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OBJECTIVE We examined the effects of the family communication environment (conversation orientation) on adult child caregivers' burden and clinical interactions and if the effects are mediated by openness to communicate about cancer, avoidant cancer communication, and social support. METHOD Caregivers of a parent diagnosed with a blood cancer (N = 121) completed an online survey of validated measures of conversation orientation (i.e., the extent to which families openly communicate), social support, cancer openness, avoidance, caregiver burden, clinical communication skills, and quality of clinical interactions. RESULTS Conversation orientation had significant indirect effects on caregiver burden, mediated by social support (β = -0.11, p < .001), as well as cancer openness and avoidance (β = -0.07, p < .001). Conversation orientation also had significant indirect effects on caregivers' communication skills with a parent's clinician, mediated by avoidance (β = 0.08, p < .01) and social support (β = 0.06, p < .001). Finally, conversation orientation had significant indirect effects on caregivers' quality of clinical interactions mediated by avoidance (β = 0.71, p < .05). CONCLUSIONS Adult child caregivers whose families communicate more openly exhibit less caregiver burden and report better clinical interaction skills and perceived quality of the clinical interaction. Avoidance emerged as a key mediating factor. Caregivers from less open communication environments may benefit from interventions that help them navigate challenging but critical caregiving conversations. This article is protected by copyright. All rights reserved.