Sickle cell disease (SCD) is a lifelong disorder that involves progressive organ damage and requires ongoing medical attention to prevent and treat episodic acute complications. Children with SCD need ongoing monitoring and extra attention that may be stressful to family members. Communication within families can help resolve family stress and may be associated with medical follow-up and management of SCD. Focus groups were conducted with 12 African American families to explore the communication that occurred within and outside of the family from the perspectives of adolescents with SCD, siblings, and parents. Factors that influence family communication were explored. The extended family was an important social network and resource to adolescents, siblings, and parents. Family member knowledge of SCD was an important factor that influenced communication about SCD; adolescents and parents communicated more easily than siblings and also reported having more knowledge of SCD than siblings. Future research focusing on the knowledge of immediate and extended family members and their recognition of their contribution to the child with SCD is recommended.

DEDICATION To my family:My husband Tim for his unyielding support and encouragement.My daughter Tiffany for her understanding, willing ear, and inspiration.My son Daniel for thinking I'm going to be an "Über" nurse.My mom and dad for bragging about me to everyone they meet.iv ACKNOWLEDGEMENTS I would like to thank Dr. Margaret Hartig, Dr. Elizabeth Tolley, and Ms. Belinda Hardy for their time and guidance while serving on my dissertation committee.