Refer medical questions to the Hospice nurse. Be aware that these may change as the patient's condition changes. It is your responsibility to stay in touch with those changing needs and to state clearly to the family what you can and cannot offer in terms of time and availability. This will prevent awkward and possibly painful misunderstandings. Regular phone calls to check in are often appreciated, and sometimes result in meaningful and substantive conversations.
Some people find it easier to open up in an unplanned phone contact than during a scheduled visit.
Again, in most instances, it is up to you to take the initiative in getting things going. Their situation is always the focus of your visit. In most instances this means listening more than talking. Avoid the natural tendency to swap medical stories or confide in them. Remember, you're establishing an objective relationship, not a subjective one.