Purpose: Supported by the Supportive Care Needs Framework (SCNF), we developed a colorectal cancer (CRC) couple-based unmet supportive care needs (USCNs) intervention program, which has been proven to be feasible. The intention was to assess what the clinical efficacy of this intervention would be in CRC couples. Methods: One hundred and sixty-eight CRC couples were randomly assigned to one of two groups: a control group (receiving normal care) or an intervention group (receiving normal care plus a five-week USCNs intervention). Information on USCNs, mutual communication, quality of life, and psychological adjustment was gathered from CRC couples both at baseline and right after the intervention. The collected data were examined using repeated measures analysis of variance (ANOVA). Results: There were 135 CRC couples who completed the five-week intervention and post-intervention outcome measures (retention rate: 80.4%). Combining with the ANOVA results (p < 0.001 for both couples) and the intervention effect sizes Cohen's d (d = 0.33-0.60 for patients, d = 0.22-0.59 for spousal caregivers), the USCNs intervention is effective in improving USCNs, mutual communication, mental health, positive emotions, and negative emotions in CRC couples. Conclusion: The CRC couple-based USCNs intervention effectively reduces USCNs and promotes cancer adjustment among CRC couples. This intervention can assist clinical staff in refining routine care components to enable couples to manage CRC more effectively. In the future, it will be essential to lengthen the follow-up duration to assess the efficacy of the intervention in the long term.