e-TC: Development and pilot testing of a web-based intervention to reduce anxiety and depression in survivors of testicular cancer

Probably not a substantial claim: may not pass S3 (load-bearing).

Four of the eight general foci of feasibility studies proposed by Bowen et al. (2009) guided the assessment of feasibility in the current study (demand, implementation, practicality and acceptability).

“they propose eight general foci of feasibility studies, four of which guided the assessment of feasibility in the current study (demand, implementation, practicality and acceptability).”

• cites Bowen et al. (2009) sourceSupported

May combine two claims.

Participants reported that e-TC reduced the stigma of mental health issues by normalising men's feelings and overcame embarrassment by providing privacy in help-seeking, consistent with masculine ideals.

“More importantly, participants reported that e-TC reduced the stigma of mental health issues, by normalising men s feelings, and overcame embarrassment by providing privacy in help-seeking, thus providing information and support in a manner consistent with masculine ideals (Galdas et al., 2014).”

• cites Galdas et al., 2014 sourcePartly supported

  The Results (Key themes; page unavailable) describe peers offering men a sense of normality, while the Discussion (page unavailable) says trusted online communities can help men open up despite expectations of masculinity. The paper does not evaluate e-TC or report that its participants experienced reduced mental-health stigma or overcame embarrassment through private help-seeking. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim.

The feasibility and acceptability of e-TC was evaluated in a manner consistent with that recommended by Bowen et al. (2009).

“The feasibility and acceptability of e-TC was evaluated in a manner consistent with that recommended by Bowen et al. (2009).”

• cites Bowen et al. (2009) sourceSupported

Classified as probably not a substantial claim.

Consultation with male consumers of health services would help increase the congruence of services with central aspects of their identities and their appeal to such consumers.

“Galdas et al. (2014) note that consultation with male consumers of health services would help increase the congruence of services with central aspects of their identities and their appeal to such consumers, in general.”

• cites Galdas et al., 2014 sourcePartly supported

  In “Implications for future research, policy and practice,” the paper recommends consulting male service users to make existing support interventions more appealing and congruent with their identities. That recommendation concerns self-management support for men living with long-term conditions; the citing sentence extends it to male consumers of health services in general. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

Desktop/laptop computers were used to access the e-TC site 88% of the time, while 7% of devices used were tablets and 5% were mobile phones.

“Desktop/laptop computers were used to access the site 88% of the time, while 7% of devices used were tablets and 5% were mobile phones.”

Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing).

A common suggestion was that having access to e-TC earlier in the illness trajectory would be beneficial.

“A common suggestion was that having access to e-TC earlier in the illness trajectory would be beneficial, because of the shock -the isolation as well (Jeremy).”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

All participants had orchidectomy and 13 (52%) had chemotherapy.

“All participants had orchidectomy and 13 (52%) had chemotherapy.”

May combine two claims. The quote only partly states this claim.

Participants were satisfied with e-TC in general, and satisfaction with e-TC was moderately high.

“Participants were satisfied with e-TC in general.”

• Also stated in: § Conclusions · plain

  “Satisfaction with e-TC was moderately high”

• AssumptionRests on an assumption: The purpose-built satisfaction questionnaire and the engagement metrics (number of site logins, average pages viewed, average session length) validly measure acceptability and feasibility of e-TC.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

One participant acknowledged that as he was two years post-surgery the course was not as relevant to him, but thought it would be very useful to have available to people coping with chemo and cancer.

“One participant acknowledged that as he was two years post-surgery the course was not as relevant to me.However I definitely think it would be very useful to have available to people coping with chemo and cancer.John)”

May combine two claims.

In the current study, the majority of men who completed less than 20% of the program reported no distress on the thermometers, while the majority of men who completed at least 80% reported at least some distress.

“Nevertheless, in the current study the majority of men who completed less than 20% of the program reported no distress on the thermometers while the majority of men who completed at least 80% reported at least some distress.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Some men suggested technical improvements, such as a placeholder or bookmark-type function, more detailed progress indicators for both the questionnaires and modules, and the need to stay on top of browser upgrades.

“Some men suggested technical improvements, such as a placeholder or bookmark-type function, more detailed progress indicators for both the questionnaires and modules, and the need to stay on top of browser upgrades.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Other participants suggested website content and features to enhance comprehensiveness, including information tailored to men's needs addressing different types of TC, stage-related treatments and associated side effects, as well as information and exercises for partners.

“However other participants put forward suggestions for website content and features that they felt would enhance the comprehensiveness of e-TC, including information tailored to men s needs addressing different types of TC, stage-related treatments and associated side effects, as well as information and exercises for partners.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Whilst participating in the pilot study, three men (12%) were seeing a psychologist and/or taking medication for psychological difficulties.

“Whilst participating in the pilot study, three men (12%) were seeing a psychologist and/or taking medication for psychological difficulties.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The provision of an Australian resource was appreciated.

“In particular, the provision of an Australian resource was appreciated, with one participant saying that at the time of his diagnosis, there wasn't a lot of Australian-based material … on testicular cancer .(Leon)”

Classified as probably not a substantial claim.

According to participants, each e-TC module took 45 to 60 minutes to complete.

“According to participants, each module took 45 to 60 minutes to complete”

Probably not a substantial claim: may not pass S3 (load-bearing).

One participant stated that it never struck him that there was something relevant to him that wasn't covered.

“One participant stated it never struck me that there was something that was relevant to me that wasn't covered (Frank).”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Participants agreed that additional tailoring and providing the option for further information if people want it would enhance ease of use of e-TC.

“although the participants agreed that additional tailoring and providing the option for further information if people want it (Jeremy) would enhance ease of use.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

e-TC was reported to be comprehensive and easy to use.

“Key highlights of the program were the survivor videos, and the reports that it was comprehensive and easy to use.”

• AssumptionRests on an assumption: The purpose-built satisfaction questionnaire and the engagement metrics (number of site logins, average pages viewed, average session length) validly measure acceptability and feasibility of e-TC.

Probably not a substantial claim: may not pass S3 (load-bearing).

The challenge of engaging in some of the cognitive tasks in e-TC was highlighted.

“However the challenge of engaging in some of the cognitive tasks was highlighted”

Probably not a substantial claim: may not pass S3 (load-bearing).

Men were on average 2.8 years post-diagnosis (SD=1.7, range=1.2-5.0).

“Men were on average 2.8 years post-diagnosis (SD=1.7,range=1.2-5.0).”

Probably not a substantial claim: may not pass S3 (load-bearing).

The structure of e-TC allowed one participant to spend more time on the modules he thought were more relevant and where he thought he was going to get something out of it.

“This participant also explained that the structure of e-TC allowed him to spend more time on the [modules] that I thought were more relevant and where I thought I was going to get something out of it.(Leon)”

May combine two claims.

Men appreciated an intervention specifically tailored to their disease and found it personally relevant to their experience.

“Men also appreciated an intervention specifically tailored to their disease, and found it personally relevant to their experience.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Participants described e-TC as user-friendly, fairly intuitive and straightforward.

“participants described the program as user-friendly (Anthony), fairly intuitive (Peter) and straightforward (Frank).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Men found techniques around anxiety management and managing negative thoughts helpful.

“Regarding the cognitive tools, what men did find helpful was probably some of the techniques around … anxiety management, trying to manage some of those more negative thoughts and the like (Leon).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Participants reported that e-TC content resonated closely with their experiences, enabling them to relate to the material.

“Participants reported that e-TC content resonated closely with their experiences, enabling them to relate to the material.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Of 51 men invited to participate, 27 (53%) consented, but 2 (4%) subsequently withdrew, giving an actual response rate of 49% (N=25).

“Of 51 men invited to participate, 27 (53%) consented, but 2 (4%) subsequently withdrew, giving an actual response rate of 49% (N=25).”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Three of these (12%) had previously seen a psychologist or psychiatrist and two (8%) had previously taken medication.

“Three of these (12%) had previously seen a psychologist or psychiatrist and two (8%) had previously taken medication.”

May combine two claims. The quote only partly states this claim.

Five of the seven (71%) men who completed <20% scored zero for both distress and impact, while only two of the 14 (14%) who completed ≥80% of the intervention scored zero on every thermometer.

“Five of the seven (71%) men who completed <20% scored zero for both distress and impact, while only two of the 14 (14%) who completed % of the intervention scored zero on every thermometer”

Probably not a substantial claim: may not pass S3 (load-bearing).

Eleven men (44%) reported a history of anxiety or depression.

“Eleven men (44%) reported a history of anxiety or depression.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

e-TC was perceived to provide reassurance that there are people out there trying to help you get through it and understand it, and to normalise their experiences.

“e-TC was also perceived to provide reassurance that there are people out there trying to help you get through it and understand it (Anthony), and to normalise their experiences by someone talking about that's a normal side effect and that can last you six to … whatever that might be … that provides me comfort, if that makes sense (Leon).”

Probably not a substantial claim: may not pass S3 (load-bearing).

The majority of participants were diagnosed with Stage I disease (60%; 24% Stage II; 16% Stage III).

“The majority were diagnosed with Stage I disease (60%; 24% Stage II; 16% Stage III).”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Most participants reported that e-TC was very in-depth and thorough, and struck a balance between providing enough information to provide comfort but not too much that men feel they don't need to raise it with their doctor.

“Overall, most participants reported that e-TC was very in-depth and thorough (Jeremy), and struck that balance between providing enough information to provide comfort but not providing too much that (men) feel they don't need to raise it with their doctor (Leon).”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The 25 participants were young (mean age=37.6 years, SD=8.0, range=27-57), well-educated (80% tertiary), employed full/part-time (84%), partnered (88%), and childless (52%).

“The 25 participants were young (mean age=37.6 years, standard deviation (SD)=8.0,range=27-57), well-educated (80% tertiary), employed full/part-time (84%), partnered (88%), and childless (52%).”

May combine two claims.

Most participants liked the interactivity of e-TC and wanted more of it.

“Most participants liked the interactivity and wanted more of it.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Of the 13 who had chemotherapy, 4 (16%) also had retroperitoneal lymph node dissection and 1 (4%) also had radiotherapy.

“Of the 13 who had chemotherapy, 4 (16%) also had retroperitoneal lymph node dissection and 1 (4%) also had radiotherapy.”

May combine two claims.

e-TC is a feasible and acceptable platform or psychological treatment option for men treated for testicular cancer, including those experiencing difficulties adjusting after treatment.

“The findings from this study suggest that e-TC is a feasible and acceptable platform for delivering information and psychological support to men treated for TC.”

• Also stated in: § Conclusions · hedged

  “e-TC appears to provide a feasible and acceptable psychological treatment option for men who are experiencing difficulties in adjusting to challenges following treatment for TC.”

• AssumptionRests on an assumption: The purpose-built satisfaction questionnaire and the engagement metrics (number of site logins, average pages viewed, average session length) validly measure acceptability and feasibility of e-TC.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

A module was described as very helpful, with practical information on work, finances and insurance, and tools for managing concern of recurrence.

“Module was described as a very helpful module.The practical information re work, finances and insurance was great.I also found a number of the tools quite helpful around managing the concern of recurrence.(Leon)”

May combine two claims.

Participants valued the inclusion of videos of other men's stories and experiences of coping with testicular cancer, and this component was highly valued.

“Participants also reported valuing the inclusion via videos of other men s stories and experiences of coping with TC.”

• Also stated in: § Insert table 2 here Discussion · boosted

  “This component of e-TC was highly-valued by the participants in our pilot study.”

• Also stated in: § Conclusions · plain

  “Key highlights of the program were the survivor videos, and the reports that it was comprehensive and easy to use.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Men felt e-TC was flexible enough to pick up what you want and what you need from the website.

“Men felt e-TC was flexible enough so [you could] pick up what you want and what you need from the website (Leon)”

Probably not a substantial claim: may not pass S3 (load-bearing).

The most common reason reported for nonparticipation was lack of time.

“The most common reason reported for nonparticipation was lack of time.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Participants felt the time commitment would not have concerned them as much if they had used e-TC closer to the time of diagnosis and treatment or if they were using it to manage anxiety or depression.

“However, participants felt the time commitment would not have concerned them as much if they had used e-TC closer to the time of diagnosis and treatment or if they were using it to manage anxiety or depression.”

May combine two claims.

The average time per session was 20 minutes (range 5-60) and the average number of pages viewed was 11 (range 3-45).

“The average time per session was 20 minutes (range 5-60) and the average number of pages viewed was 11 (range 3-45).”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Feedback suggested that overall e-TC is a fantastic information resource, easy to access and use.

“In terms of how easy e-TC was to use, feedback suggested that overall it's a fantastic information resource, easy to access and use (Neil)”

Probably not a substantial claim: may not pass S3 (load-bearing).

At baseline, two (8%) of the men reported FCR symptoms often or all of the time.

“At baseline, five (20%) of the men reported clinically significant levels of anxiety, one (4%) reported clinically significant depression, and two (8%) reported FCR symptoms often or all of the time .”

Classified as probably not a substantial claim.

Online self-management interventions may be a more acceptable form of help-seeking for men, as they enable men to take control over managing their distress and to do so privately, in a way that does not undermine their outward projection of masculine ideals.

“Online self-management interventions may be a more acceptable form of help-seeking for men, as they enable men to take control over managing their distress (promoting self-sufficiency and independence) and to do so privately, in a way that does not undermine their outward projection of masculine ideals.”

May combine two claims.

Younger cancer survivors and those diagnosed with prostate or testicular cancer were particularly likely to hold positive attitudes towards web-based self-management.

“Younger cancer survivors and those diagnosed with prostate or testicular cancer were particularly likely to hold positive attitudes towards web-based self-management (Jansen, 2015).”

• cites Jansen, 2015 sourceNot checked — no full text of the source

May combine two claims.

e-TC appears to be a feasible and acceptable online intervention for survivors of testicular cancer.

“e-TC appears to be a feasible and acceptable online intervention for survivors of testicular cancer.”

May combine two claims.

The HADS and Fear of Recurrence Scale were not used to evaluate the efficacy of e-TC in this study; they were included to help characterise the study sample and evaluate the feasibility of using these measures in a future study specifically designed to evaluate the efficacy of e-TC.

“The HADS and Fear of Recurrence Scale were not used to evaluate the efficacy of e-TC in this study.They were included to help characterise the study sample and evaluate the feasibility of using these measures in a future study specifically designed to evaluate the efficacy of e-TC.”

May combine two claims.

Users of online interventions may prioritise accessing only information deemed immediately and personally relevant, suggesting that completion rates may not be a good indicator of program acceptability and feasibility.

“Thus users of online interventions may prioritise accessing only information deemed immediately and personally relevant, a point made by a number of e-TC pilot participants, suggesting that completion rates may not be a good indicator of program acceptability and feasibility.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Fear of cancer recurrence in the past month was assessed at baseline and follow-up using the 4-item Fear of Recurrence Scale (Rabin, Leventhal, & Goodin, 2004), in which individual item scores are averaged to give a score range of 1-4 with higher scores indicating greater FCR.

“Fear of cancer recurrence in the past month was assessed at baseline and follow-up using the 4-item Fear of Recurrence Scale (Rabin, Leventhal, & Goodin, 2004), in which individual item scores are averaged to give a score range of 1-4 with higher scores indicating greater FCR.”

• cites Rabin, Leventhal, & Goodin, 2004 sourceNot checked — no full text of the source

Classified as probably not a substantial claim. May combine two claims.

A 2015 systematic review noted the paucity of studies reporting on the efficacy of eHealth interventions for cancer patients or survivors and called for further development and evaluation using validated measures.

“A 2015 systematic review noted the paucity of studies reporting on the efficacy of eHealth interventions for cancer patients or survivors and called for further development and evaluation using validated measures (McAlpine et al., 2015).”

• cites McAlpine et al., 2015 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Qualitative data suggested that if e-TC was made available closer to the time of diagnosis when need is perceived to be greater, men may be more motivated to make time.

“Qualitative data suggested that if e-TC was made available closer to the time of diagnosis when need is perceived to be greater, men may be more motivated to make time.”

May combine two claims.

Several important differences between testicular and prostate cancer survivors, namely age, disease trajectory, treatment side-effect severity, and long-term psychosocial impacts, support the need for an intervention specifically tailored to testicular cancer survivors.

“However several important differences between testicular and prostate cancer survivors, namely age, disease trajectory, treatment side-effect severity, and long-term psychosocial impacts (Luckett, King, & Stockler, 2010), support the need for an intervention specifically tailored to this group.”

• cites Luckett, King, & Stockler, 2010Not checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Study approval was granted by relevant institutional ethics committees and the study was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000111673).

“Study approval was granted by relevant institutional ethics committees and the study was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000111673).”

Classified as probably not a substantial claim. The quote only partly states this claim.

Purposive sampling of six men allowed exploration of both e-TC experiences and reasons for non-completion.

“This purposive sampling allowed exploration of both e-TC experiences and reasons for non-completion.”

May combine two claims.

The sample is unlikely to be representative of all men who have undergone testicular cancer treatment; they were primarily urban and motivated to help with research.

“A key limitation of this study is that the sample is unlikely to be representative of all men who have undergone TC treatment; they were primarily urban and motivated to help with research.”

Classified as probably not a substantial claim.

The approach of having several testicular cancer survivors on the project team was directly in line with the recommendation to consult male consumers, in order to maximize the likely relevance and usefulness to other testicular cancer survivors.

“Our approach was directly in line with this recommendation, as we had several TC survivors on the project team in order to maximize the likely relevance and usefulness to other TC survivors.”