Background: Veterans diagnosed with hematologic disorders, including multiple myeloma (MM), monoclonal gammopathy of undetermined significance (MGUS), smoldering myeloma (SM), and myelodysplastic syndrome (MDS) often experience fragmented care and gaps in disease-specific education. These types of disorders are reported at higher rates in the veteran population, potentially due to environmental exposures encountered during military service. While the U.S. Department of Veterans Affairs (VA) provides extensive healthcare services, many veterans still experience obstacles to care, including fragmented care delivery, limited disease-specific education, and restricted access to clinical trials. To improve care coordination and patient engagement, the Cincinnati VA Medical Center (CVAMC) partnered with the Leukemia & Lymphoma Society (LLS) to pilot a structured educational and support-based intervention.

Objective: The purpose of this pilot project was to enhance disease-specific knowledge, care navigation, and access to support resources among veterans diagnosed with hematologic disorders, including MM, MGUS, MDS and SM. Conducted through a collaboration between the CVAMC and LLS, the project aimed to integrate healthcare coaches' patient navigation into the existing VA system and peer support services into routine care, with the goal of improving patient education, treatment engagement, and access to supportive services for this high-risk population

Methods: Veterans with confirmed MM, MGUS, SM, or MDS were referred by their VA providers and invited to participate in a one-on-one health coaching session. The session covered education regarding diagnosis, treatment pathways, symptom recognition, and offered access to external resources (LLS). Participation was voluntary, and verbal consent was obtained. Pre- and post-session surveys were administered verbally to assess knowledge gains across key domains. Responses were securely recorded and de-identified for analysis. Quantitative methods included descriptive statistics, chi-square tests for categorical associations, ANOVA to assess age differences by diagnosis, linear regression to examine trends over time, and Welch's t-tests to compare outcomes based on patients' understanding of the clinical visit purpose.

Results: Of the 101 veterans enrolled, 95 completed all study components. Participants were predominantly male (97.9%), with a mean age of 75.2 years (SD = 6.3). MGUS accounted for most diagnoses (78.9%), followed by MM (16.8%), SM (3.2%), and MDS (1.1%). At baseline, less than half of participants (45.3%) demonstrated clear understanding of their diagnosis; fewer reported knowledge of their treatment plan (31.6%) or ability to identify red flag symptoms (17.9%). Significant differences in baseline understanding were observed across diagnosis types (p < .01). Linear regression revealed a positive trend in disease comprehension with positive intervention by the healthcare coach (β = 0.0255, p = .050). Participants who reported understanding the purpose of their clinical visit showed significantly greater understanding of both their diagnosis (p < .0001) and treatment plan (p < .0001). Following the intervention, 15 veterans were formally referred to LLS services, with one veteran initiating participation independently in the First Connection peer support program.

Conclusion: This pilot intervention demonstrated that structured health coaching, paired with navigation to disease-specific resources, can meaningfully improve comprehension and engagement among veterans with hematologic disorders. The association between visit purpose awareness and knowledge underscores the importance of clear, individualized communication in routine care. By aligning internal and external support, this model offers a scalable, veteran-centered approach to improve care quality and continuity within complex patient populations. Broader implementation and longitudinal outcome tracking are warranted.

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2025
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