The aim of this study is to evaluate the effects of mandala art therapy on psychological resilience and coping with cancer in patients undergoing colorectal cancer surgery.

This study was conducted as a randomized controlled trial with a pre-test-post-test design, including intervention and control groups. The study will be conducted between January 2026 and December 2026 with patients undergoing colorectal cancer surgery. The G.power 3.1.9.7 program was used for sample size calculation. The sample size was determined as 28 individuals in each group, considering equal sample sizes in the experimental and control groups, a 95% confidence interval (type I error 5%), and statistical power of 80% (type II error 20%) with an effect size of d=0.50. However, considering a possible 20% data loss, 35 individuals will be included in each group, resulting in a total sample size of 70 individuals.

Sample selection will be made using sequential sampling according to inclusion criteria. Patients will then be randomly assigned to the experimental group (A) and the control group (B) using block randomization (four-block). First, 15 blocks of four, such as AABB, ABAB, ABBA, BBAA, BABA, BAAB, etc., will be prepared by the researcher and statistician. Individuals will then be divided into two groups according to the prepared list; this process will be repeated continuously until the sample size is complete.

Three data collection forms were used. SPSS 22.00 software package was used for data analysis. Skewness and kurtosis analyses were performed to determine the normality of the data distribution. Frequency (n) and percentage (%) distributions were calculated to determine the sociodemographic and clinical characteristics of the participants. Independent samples t-test was used to determine the mean differences between two independent groups, dependent samples t-test was used to compare pre- and post-intervention measurements, and repeated measures one-way analysis of variance (ANOVA) was used. Cohen's d effect size was calculated to evaluate the significance of the difference between groups in terms of the intervention. The statistical significance level was accepted as p<0.05.

Inclusion Criteria:

• To communicate,
• Aged 18 or older,
• Agreed to participate
• Scheduled for colorectal cancer surgery.
• No physical disability of the upper extremities,
• no visual problems,
• no history of psychotic drug use,
• pain intensity and fatigue level ≤3 points according to VAS-10 before MST application,
• will be hospitalized for 3 days postoperatively,

Exclusion Criteria:

• Over 74 years old,
• has not completed mandala art therapy application,
• is not compliant with the application,
• has a history of previous psychiatric diagnosis.

We plan to publish the study in an international journal.

Data will be collected for six months.

This study will utilize a sequential sampling method. Patients will then be randomly assigned to the experimental group (A) and the control group (B) using block randomization (four-block). First, 15 blocks of four, such as AABB, ABAB, ABBA, BBAA, BABA, BAAB, etc., will be prepared by the researcher and statistician. Individuals will then be divided into two groups according to the prepared list; this process will be repeated continuously until the sample size is complete.