Harold P. Freeman, MD
When Harold P. Freeman, MD, began visiting American cities more than 25 years ago to learn about the effects of race and poverty on cancer outcomes, few people were talking about disparities in access and care.
By the end of his seven-city tour, Freeman, who was then president of the American Cancer Society, not only had enough testimonies from patients with cancer and their families to form a groundbreaking portrait of the challenges that poor people face in obtaining care, he also had a sharper vision of the patient navigation concept that he would pioneer.
Throughout a long and storied career in medicine, Freeman has met five US presidents, including three whose cancer panels he chaired, worked alongside celebrities such as LeBron James and Kareem Abdul-Jabbar, and was so well known that then-candidate Barack Obama remembered the first time he met Freeman better than Freeman remembered meeting him.
His efforts have been recognized with a Lasker Award for public service, the American Cancer Society’s Medal of Honor, a special award from the American Society of Clinical Oncology, and a host of other honors. Last year, Freeman won a Giants of Cancer Care Award in the Community Outreach/Education category.
Through it all, Freeman has been motivated by the needs of the patients that he met in his daily practice, starting in Harlem in the late 1960s, and has not stopped focusing attention on his core mission of improving access to care for people regardless of economic status.
“You shouldn’t die because you are poor, from cancer or anything else,” he said. “Patient navigation is one of those elements that, in my view, tends to temper the point that we have great systems, wonderful specialists, powerful cancer centers, and we say we can give the best care in the world—but they don’t say what they should say, which is, ‘If you can pay for it.’”
Patient Navigation Takes Hold
At the age of 83, Freeman spends most of his time teaching and promoting his signature idea of patient navigation—systems through which trained nonprofessionals and oncology care providers help patients with cancer to obtain the care they need in timely fashion throughout their journey. The Harold P. Freeman Patient Navigation Institute in New York City trains nurses and other healthcare providers and community members in how best to guide patients through the continuum of cancer care, from outreach efforts to the finding of abnormalities to timely diagnosis and treatment. Individuals who complete the 2-day training program receive a certificate in patient navigation.
Although Freeman developed the concept for patients with cancer, the institute has expanded the model to include managing individuals with other chronic conditions, such as diabetes, heart disease, infectious diseases, and mental health conditions. In essence, patient navigation is about helping patients overcome barriers to care, whether they are complex barriers involving fear, knowledge, and a lack of insurance coverage or easier-to-solve obstacles like getting to appointments.
“Whatever the barrier is, it’s the navigator’s job to solve it, so the patient can move in a timely way from the point of finding to diagnosis and treatment,” Freeman said. Beyond that premise, navigators are trained to “virtually integrate” the fragmented healthcare system for each of their patients, he said.
Under Freeman’s concept, the level of professional training that a navigator needs depends on the stage at which he or she would be helping patients; oncology nurse navigators, for instance, would step in to assist patients in understanding the implications of their diagnosis and the recommended treatment plan.
Freeman initially developed his navigation ideas to help people without economic resources gain access to care. A 2005 federal law that established demonstration programs in medically underserved communities help foster his concepts.
Since then, elements of patient navigation have been embraced by cancer centers throughout the country. The American College of Surgeons has made a patient navigation process part of its accreditation standards for hospital cancer programs.
Freeman believes that the patient navigation system is particularly helpful in guiding patients through the highly specialized healthcare system. “We don’t have a system that is necessarily friendly to the movement of the individual through a complex journey, including things that have to happen in the community early on, such as the outreach element, and then the clinical element getting from finding to treatment and followed by supportive care back in the community,” said Freeman. “We’re concentrating on specializing.”