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EURURO-8981; No. of Pages 2 E U R O P E A N U RO L O GY X X X ( 2 019 ) X X X – X X X available at www.sciencedirect.com journal homepage: www.europeanurology.com Platinum Priority – Editorial Referring to the article published on pp. x–y of this issue Introduction of Telemedicine During the COVID-19 Pandemic: A Challenge for Now, an Opportunity for the Future Roman Sosnowski a,*, Hubert Kamecki a, Steven Joniau b, Jochen Walz c, Zachary Klaassen d, Joan Palou e a Department of Urogenital Cancer, Maria Skłodowska-Curie National Research Institute of Oncology in Warsaw, Warsaw, Poland; b Department of Urology, University Hospitals Leuven, Leuven, Belgium; c Department of Urology, Institut Paoli-Calmettes Cancer Centre, Marseille, France; d Department of Surgery, Division of Urology, Augusta University – Medical College of Georgia, Augusta, GA, USA; e Oncology Urology Unit, Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain The ongoing COVID-19 pandemic is having a dramatic of telemedicine, especially with regard to maintaining impact on the availability of both inpatient and outpatient professionalism, privacy, confidentiality, high quality of data health care services. In order to maintain the consistency of transmission, and adequate levels of comprehension. ambulatory care in view of strict social distancing measures The abrupt need to adopt telemedicine in everyday being enforced, much of patient counseling is now being outpatient practice has been a major challenge for performed with the use of telemedicine. This means of urologists, as many have not been trained in and are not communication was formerly considered as relatively novel experienced in the field of electronic counseling. Therefore, and uncommon, but is now becoming increasingly wide- increasing awareness of the safety and efficacy of telemedi- spread, having been suddenly implemented in clinical cine, as well as providing urologists with guidelines and practice. This unprecedented increase in the role of practical aids in regard to this form of practice, is a desirable telemedicine and resulting concerns with regard to the aim to pursue. However, we should keep in mind that it is principles, safety, and efficacy of remote medical counseling not only physicians who may find the field of telemedicine have become a major point of interest in the medical new, as a great majority of urology patients might have community. In this issue of European Urology, two never experienced an electronic consultation. This is of trailblazing articles with regard to the use of telemedicine special concern for elderly individuals, who may account for in urology are published. as much as half of the total population of urology patients Novara et al [1] present results from a systematic review of [3]. Given that they may present variable degrees of the efficacy and safety of various electronic-based health- cognitive impairment, the novelty of a consultation via related interventions for patients with urologic conditions. electronic communication may cause significant confusion As demonstrated in the text, the available evidence, although or distress to them, especially in cases of concurrent hearing heterogeneous and mainly limited to particular groups of loss or other forms of disability. patients, shows that telemedicine should be considered at Therefore, as an addition to recommendations by least noninferior to traditional counseling in terms of both Socarrás et al [2], we would like to emphasize the major effectiveness and maintaining proper clinical judgment, as role of the urologist in adjusting the consultation process to well as patient-perceived quality of the consultation. In order best fit the variable needs of the patient. It is important to to provide urologists with a guideline on how to safely and choose the communication tool in accordance with the efficiently perform consultations via telemedicine, Socarrás capabilities and preferences of the patient. We should allow, et al [2] describe the principles of several significant aspects encourage, and enable the person accompanying the DOIs of original articles: https://doi.org/10.1016/j.eururo.2020.06.031, https://doi.org/10.1016/j.eururo.2020.06.025. * Corresponding author. Department of Urogenital Cancer, Maria Skodowska-Curie National Research Institute of Oncology in Warsaw, Roentgena 5, 02-781 Warsaw, Poland. Tel.: +48 22 5462000; Fax: +48 22 5463053. E-mail address: Sosnowski@pib-nio.pl (R. Sosnowski). https://doi.org/10.1016/j.eururo.2020.07.007 0302-2838/© 2020 Published by Elsevier B.V. on behalf of European Association of Urology. Please cite this article in press as: Sosnowski R, et al. Introduction of Telemedicine During the COVID-19 Pandemic: A Challenge for Now, an Opportunity for the Future. Eur Urol (2020), https://doi.org/10.1016/j.eururo.2020.07.007 EURURO-8981; No. of Pages 2 2 E U RO P E A N U R O L O GY X X X ( 2 019 ) X X X – X X X patient to participate in the encounter in order to provide medical counseling is a promising open-ended field of emotional support, improve the effectiveness of communi- investigation. cation, and help in decision-making. If necessary, informa- In our opinion, all reasonable efforts should be now tion should be repeated as many times as needed, for it is aimed at training health care practitioners in providing the responsibility of the physician to make certain that the best-quality patient-centered care via telemedicine. Tech- communication was effective. Patients should not be left nical aspects of training should not be neglected, as without instructions on how to make contact if any technical issues were reported to be a relevant factor problems arise. Early follow-up should be scheduled in impacting the efficacy of consultations [6]. Further studies cases of any doubt regarding a patient’s comprehension or should assess the safety and efficacy of ongoing experiences compliance. All of the cardinal principles of patient- with telemedicine during the COVID-19 pandemic, both in centered medicine should be followed when providing terms of the current quality and efficacy and the long-term care via telemedicine, especially in view of the significant outcomes of widespread adoption of remote health care psychological burden of the ongoing pandemic and systems. These endeavors could help us not only in better widespread social isolation, which may further increase preparing for possible crises in the future but also in the high rates of depression and anxiety disorders among developing the best standards of care while establishing the elderly and cancer patients [4]. We should keep in mind that role of telemedicine for contemporary practice. a patient for whom electronic counseling is suddenly We hope that on the basis of the new experience and rearranged in lieu of a traditional visit may experience challenges we are facing today, we will soon be able to raise significant concerns regarding the consistency of their care medical care in urology to a new level. and it is the role of the physician to provide comfort and reassurance. Although the current widespread adoption of telemedi- Conflicts of interest: The authors have nothing to disclose. cine has been imposed by the ongoing crisis rather than being voluntarily introduced, which undoubtedly appeared References to be a significant challenge, we believe that once these [1] Novara G, Checcucci E, Crestani A, et al. Telehealth in urology: a difficulties have been successfully overcome, there is a systematic review of the literature. How much can telemedicine be chance that electronic consultations will become a routine useful during and after the COVID-19 pandemic? Eur Urol. Eur Urol means of communication within medical care. After gaining (2020), https://doi.org/10.1016/j.eururo.2020.06.025. expertise with telemedicine, both physicians and patients [2] Socarrás MR, Loeb S, Teoh JYC, et al. Telemedicine and smart- will probably discover the opportunities of remote medical working: recommendations of the European Association of Urology. counseling in everyday practice, namely the convenience of Eur Urol (2020), https://doi.org/10.1016/j.eururo.2020.06.031. [3] Kim HJ. New horizons in geriatric urology. Korean J Urol 2015;56:335–6. smart working (for the physician), time and resource [4] Parpa E, Tsilika E, Gennimata V, et al. Elderly cancer patients’ savings (for the patient), better availability and accessibility psychopathology: a systematic review: aging and mental health. of consultations, and improved follow-up and contact Arch Gerontol Geriatr 2015;60:9–15. possibilities. Moreover, as demonstrated by Novara et al [5] Edelman LS, McConnell ES, Kennerly SM, et al. Mitigating the effects [1], electronic-based systems have potential not only for of a pandemic: facilitating improved nursing home care delivery medical counseling but also in monitoring lifestyle inter- through technology. JMIR Aging 2020;3:e20110. http://dx.doi.org/ ventions. Telemedicine could also become useful in online 10.2196/20110. patient self-education and in improving other aspects of [6] Acharya RV, Rai JJ. Evaluation of patient and doctor perception care delivery [5]. We believe that the pursuit of novel toward the use of telemedicine in Apollo Tele Health Services, India. applications of remote health care systems other than just J Family Med Prim Care 2016;5:798–803. Please cite this article in press as: Sosnowski R, et al. Introduction of Telemedicine During the COVID-19 Pandemic: A Challenge for Now, an Opportunity for the Future. Eur Urol (2020), https://doi.org/10.1016/j.eururo.2020.07.007