Purpose <p>To explore the unmet supportive care needs (USCNs) in colorectal cancer survivors and their spousal caregivers and identifying factors influencing USCNs from a dyadic perspective.</p> Methods <p>In this cross-sectional survey, a total of 343 dyads consisting of Chinese colorectal cancer survivors and their spousal caregivers were recruited from a dyadic perspective. This study evaluated participants’ USCNs, psychological distress of anxiety and depression, and benefit finding. The Actor-Partner Interdependence Mediation Model (APIMeM) as data analysis approaches was used to capture the bidirectional and mediating effects between the variables, revealing key factors influencing USCNs in colorectal cancer couples.</p> Results <p>A total of 343 colorectal cancer couples were surveyed, reporting different USCNs. The analysis revealed that psychological distress and benefit finding play a central role in influencing USCNs. These factors affect the dyadic health outcomes of both cancer survivors and their spousal caregivers through bidirectional relationships. Specifically, psychological distress influences USCNs through its impact on benefit finding, which mediates the relationship between psychological distress and unmet care needs in the dyads.</p> Conclusions <p>This study highlights the USCNs and its influencing factors within colorectal cancer couples. The APIMeM findings suggest that USCNs can be enhanced by reducing psychological distress and strengthening the protective role of benefit finding. In response to the unique needs of colorectal cancer couples, tailored psycho-social supportive care interventions should be developed, focusing on alleviating psychological distress and reinforcing the positive aspects of benefit finding, thereby fostering stronger bi-directional relationships and improving USCNs in this population.</p>