This study aims to understand how the ability to identify and describe specific emotions (called "emotional granularity") influences coping and adaptation ("resilience") in young and middle-aged colorectal cancer survivors.

The main questions to be answer are:

1. How does emotional granularity help build resilience during cancer recovery?
2. How does emotion regulation contribute to resilience building?
3. What specific emotional needs and challenges do survivors experience?

This is an observational study where no experimental treatments are provided. Participants will complete an online questionnaire about background, emotions, ways of managing emotions, and ability to cope with stress. A subset of participants will then be invited to take part in a private, 30-60 minute interview to share personal experiences and feelings in more detail.

Colorectal cancer (CRC) survivors, particularly young and middle-aged adults, frequently experience substantial emotional and psychosocial challenges after treatment completion. Emotional distress, social role disruption, and difficulties in adapting to long-term survivorship may negatively affect resilience and quality of life. Emotional granularity, defined as the ability to identify and differentiate subtle emotional experiences, has been proposed as a potential mechanism that may enhance adaptive emotion regulation and psychological resilience.

This sequential mixed-methods study aims to investigate the relationship between emotional granularity, emotion regulation, and resilience among young and middle-aged CRC survivors, and to explore survivors' emotional experiences and psychosocial support needs to inform future intervention development.

The study consists of two phases. In the first phase, a cross-sectional survey will be conducted among young and middle-aged CRC survivors recruited from teaching hospitals affiliated with Soochow University and Jiangsu University in Suzhou, Jiangsu Province, China. Participants will complete validated Chinese-language questionnaires assessing emotional granularity, emotion regulation difficulties, and resilience. Mediation analysis will be performed to examine whether emotion regulation mediates the association between emotional granularity and resilience.

In the second phase, purposive sampling will be used to recruit participants with varying levels of emotional granularity scores from the quantitative phase. Semi-structured individual interviews will be conducted to explore participants' emotional experiences, coping strategies, emotional support needs, and perceptions regarding emotion-focused interventions. Qualitative findings will be integrated with quantitative results to provide evidence supporting the future development of emotional granularity-based psychosocial interventions for CRC survivors.

Inclusion Criteria:

• Young and middle-aged adult patients (age in the range of 18-60 years);
• Patients diagnosed with CRC;
• Patients have completed primary treatments (e.g., surgery, chemotherapy, and/or radiotherapy) without experiencing a recurrence of CRC;
• Patients able to use a smartphone and agree to participate in the study.

Exclusion Criteria:

• Patients who have not been informed of their cancer diagnosis due to family decision to withhold information;
• Patients suffering from severe conditions that may affect participation or assessment, such as significant cognitive impairment, psychiatric disorders, or communication disorder.

The study population will consist of samples and data obtained from three major regional tertiary hospitals in Suzhou, Jiangsu Province:

1. The First Affiliated Hospital of Soochow University: A leading comprehensive tertiary Grade A hospital and a major clinical, teaching, and research center in the region.
2. The Second Affiliated Hospital of Soochow University: Another key comprehensive tertiary Grade A hospital providing high-level medical services to the urban population.
3. Kunshan First People's Hospital Affiliated to Jiangsu University: A premier tertiary Grade A hospital representing the high-quality healthcare infrastructure of county-level cities within the Suzhou administrative area.

This selection encompasses top-tier medical institutions from both the central urban district of Suzhou and a developed county-level city (Kunshan), ensuring a representative and diverse sample of the patient population and healthcare delivery within the Suzhou region.

A final decision regarding sharing individual participant data (IPD) has not yet been finalized. This is due to the need for further internal discussions and consultations with all collaborating institutions, particularly regarding compliance with cross-border data transfer regulations under China's Personal Information Protection Law (PIPL) and ethical guidelines governing participant privacy. Additionally, the feasibility of robust de-identification processes and secure data-sharing mechanisms is being evaluated to ensure participant confidentiality. The final decision will be determined before study completion and will align with journal requirements, participant consent agreements, and institutional policies.