e-TC 2.0 - Further development and pilot testing of an online psychological intervention aimed at reducing anxiety, depression and fear of cancer recurrence in testicular cancer survivors

e-TC 2.0 is comprised of six interactive modules, including psycho-educational material, short survivor and educational videos, and offline exercises. e-TC 2.0 presents information and exercises tailored according to user-reported relationship status (partnered or unpartnered), side-effect profile and baseline treatment goals, to ensure relevance. Modules were designed to take approximately an hour to complete, depending on level of engagement. Content and skills taught are detailed below. Module number: 1 Module name: Foundations: Putting together a toolkit to manage stress and worry Topics covered: - Normalises reactions to testicular cancer (TC) and its treatment. - Introduces key skills (e.g. mindfulness) Skills/exercises: - Identifying and challenging unhelpful thoughts. -Mindfulness Module number: 2 Module name: After treatment: How you feel after treatment for TC Topics covered: - Emotional impact of TC (e.g. anxiety, depression, fear of cancer recurrence, anger). - Normalises emotional reactions Skills/exercises: - Acceptance and Commitment Therapy principles of defusion, acceptance and connection. - Revisits mindfulness Module number: 3 Module name: Changes: Physical changes and side effects Topics covered: Information about changes and side effects by treatment type: 1. Orchidectomy; 2. chemotherapy/radiotherapy; 3. node dissection and other surgeries Skills/exercises: - Relaxation techniques. - Introduction to Tai Chi and Qi Gong. - Revisits identifying and challenging thoughts. - Revisits acceptance Module number: 4 Module name: Being a ‘man’: Masculinity and sexuality Topics covered: - Effect of TC and its treatment on masculinity and sexuality. - Acknowledges changes and loss. - Dispels myths and stereotypes Skills/exercises: Revisits identifying and challenging thoughts Module number: 5 Module name: Significant others: Relationships and communication Topics covered: - Explores potential impact of TC and its treatment on relationships with current/future partners, family and friends. - Enhancing communication Skills/exercises: - Listening skills. - Assertive communication Module number: 6 Module name: Moving forward: Life after TC Topics covered: Information about survivorship issues (e.g. existential concerns, fear of cancer recurrence, physical health, practical concerns) and practical strategies for managing concerns Skills/exercises: - Identifying values, - Therapeutic writing, - Detached mindfulness, - Worry postponement, - Problem solving, - Goal setting, -Benefit finding - Who will deliver the intervention? How will be delivered? The intervention will be delivered individually and on an online basis. - The number of times the intervention will be delivered and over what period of time? The intervention is accessible any day, any time. The intervention is self-paced, thus, time will vary for each participant. Each module should take approximately 1 hour to complete. - The intervention will be personalised depending on participant’s relationship status, side effects profile and baseline treatment goals. These elements will be identified through the baseline questionnaires. According to the participants responses (partnered or not), the intervention will show a few different content/resources in the corresponding modules. This is important because the experience of testicular cancer survivors and its impact on social and sexual relationships can be different based on relationship status. The side-effects profile and baseline treatment goals are different for each participant, so the intervention needs to provide them with relevant specific resources accordingly.