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1.1  BACKGROUND OF STUDYCancer which is awell-known silently fearsome type of disease has been one of the main causes ofthe death of the human beings throughout the global range. Long ago, before theadvancement of the technology as well as the available modernized treatments, thepeople had been suffered with cancer without even knowing the existence of thistype of disease which nowadays, as eloquently stated by MedicalNewsToday, ithas been varies over 100 different type of cancer (2016).

The second highestcommon type of deadly disease is cancer in United States of America and can bein a portion of 1 from every 4 deaths (MedicalNewsToday, 2016; cited fromAmerican Cancer Society). As stated by the National Cancer Institute, breastcancer has been the most common leading type of cancer, while it has beenexpectedly in 2017 to be more than 255,000 new reported occurrences in UnitedStates (2017). Besides that, it has also been stated that lung cancer andprostate cancer are the next highest occurrences type of cancer whilst as for thecolorectal cancer which has been combined as one due to the often referral ofthe name, there are approximately about 95,520 and 39,310 respectively referredto new expected colon and rectal cancer which give a sum of 135,430 in total ofnew expected cases of colorectal cancer (National Cancer Institute, 2017). Dueto the suffering of disease, people tend to be mostly experienced with thedifficulty to live their life in a normal way possible. There is so far, notechnology that is able to nourish the psychological being of the human as theyare trying to endure and fight the disease they suffered with during theirentire life.

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As recently indicated by Grimmett, Haviland, Winter, Calman, Din,Richardson, Smith and Foster, there is indeed the cancer aftercare self-managementthat has been highlighted and mushrooming but there is very few management ondisease-related problems which depends on the confidence of the patient tofight with cancer symptoms or as known as the patient’s self-efficacy and thechanges of this throughout the time (2017). Thus, the importance of theself-efficacy is quite important to be explored as to identify the pattern ofit as well as its association with other factors. In regard of colorectalcancer, it has been the second highest occurrence after breast cancer whichrated as most common cancer among men patients and third most common canceramong the women patients in Malaysia.

Besides colorectal cancer which can beclassified as one of the gastrointestinal cancer, there are other cancer thatrelated to human digestive systems such as started from esophagus, stomach,liver, gallbladder, pancreas, large and small intestine, rectum as well asanus. In this globalization era, there are many patients that have been exposedwith so many information about their health status especially their disease asit could be reached only with one click with the utilization of gadget. Despiteknowing the fact of their disease, humans have not too aware of their ownself-efficacy and how it related with anxiety and depression level as theysuffered with certain disease like cancer. As for anxiety, it can be referredas being fear or having worriment over time which getting worse throughout theperiod and affects the life of a person while the feeling of discouragement,being sad, empty hope, unmotivated and lack of interest in life which theyinfluence the activity daily living as a normal person for about two weeks andmore can be regarded as depression. Thus, do the patients really know on howgreat they are in handling themselves and how to improve themselves in term ofbeing confidence that is self-efficacy while caring of themselves? And howtheir self-efficacy status and pattern affect their psychologicalcharacteristic such as anxiety and depression level in adapting with theircancer? Self-efficacy happened to be associated with the other factors besidesthe psychological factors that are physical and social factors.

As studies byKohno, Maruyama, Matsuoka, Matsushita T., Koeda and Matsushima E.,self-efficacy and psychological factors such as anxiety and depression arestrongly related to each other whilst the variety of treatments at certainstages in term of psychological interventions performance are greatly necessaryamong the patients of gastrointestinal cancer patients (2010). Laconically,this study will explore the association between self-efficacy with anxiety anddepression among gastrointestinal cancer patients. 1.2  PROBLEM STATEMENTHaving to adapt with thefact of being a cancer survivor, life is not as easy as a plain sailing.Therefore, the inner quality that motivates a person in enduring such hardshipis absolutely important as that is how their self-efficacy can improve theirpsychological factors. In fact, the outstanding psychological adjustments are presentedwhen the gastrointestinal cancer patients have high level of self-efficacy (Kohnoet al.

, 2010). Besides that, there is a significant association between lowerself-efficacy which resulted in higher deprivation, domestic status, increasedco-morbidities, worse level of fatigue and pain, decreasing positivity and morenegativity (Grimmett et al., 2017). In general, cancer patients despiteunderstanding their health status and condition, do they know the level oftheir self-efficacy, how this quality may affect their psychological factorssuch as anxiety and depression and do they even know how to overcome thisproblem in order to be better in caring for themselves and improve theirpsychological adjustments? Expectantly and in a great desire of achieving theobjectives, this study may expose about the status of self-efficacy and itsrelations with the anxiety and depression level dedicatedly amonggastrointestinal cancer survivors.1.3  SIGNIFICANCE OF STUDYIn conducting this study,the researcher is having the desire to discover the status of self-efficacy andits association with level of anxiety and depression among gastrointestinalcancer survivors in Hospital Tengku Ampuan Afzan (HTAA) which is located atKuantan.

In Malaysia, this kind of study has not been widely highlighted despiteof the advancement of the technology and the upgraded treatment of cancer. Assuch, the number of the gastrointestinal cancer patients have been growing asthe second most leading of cancer-caused death which indicates that the primaryintervention of health care in promoting the healthy lifestyle as well as theearly screening in order to detect this cancer has been successfully achievedwith the upgraded way of treating cancer. However, how great the self-efficacyof the survivors is being questioned as well as its role as the influencer oftheir other health aspects like psychological status.Thus, desirably thisstudy may contribute such a great result in assisting the health care personnelespecially nurses whose knows as one of the closest staffs that help thepatients during hospitalization. The nurses may give a great help ininfluencing the patients related to their self-efficacy status, as well asattending to their anxiety and depression in order to enhance their life to bebetter in surviving their cancer life by being a good assistance to patientswhen they are in a great need of support system after and ongoingly beingtreated as cancer patients.

 1.4  RESEARCH QUESTIONS1.      Whatis the status of self-efficacy of gastrointestinal cancer patients?2.      Howis the self-efficacy associated with the level of anxiety and depression ofgastrointestinal cancer patients?1.5  RESEARCH OBJECTIVES1.5.1       GENERALOBJECTIVESTodetermine the status of self-efficacy among gastrointestinal cancer patients.1.

5.2       SPECIFICOBJECTIVES·        To explore the level of anxiety amonggastrointestinal cancer patients.·        To investigate the depression level ofgastrointestinal cancer patients.·        To evaluate the association betweenself-efficacy with anxiety and depression among gastrointestinal cancerpatients. 1.6  HYPOTHESIS1.6.

1       NULLHYPOTHESIS·        There is no association betweenself-efficacy with anxiety and depression among gastrointestinal cancerpatients.1.6.2       ALTERNATIVEHYPOTHESIS·        There is association between self-efficacywith anxiety and depression among gastrointestinal cancer patients. 1.7  OPERATIONAL DEFINITION·        Cancer: Abnormal growth of cell which mayspread and invade other bodily parts which is known as malignant tumor.·        Gastrointestinal: including to both thestomach and intestines.·        Self-efficacy: the power and confidence toachieve wanted result or effect.·        Anxiety: feeling of fear of being nervousabout what might happen in future·        Depression: serious condition as theperson feels terribly sad, unwanted and hopeless which influence the normal wayof living.

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