Objective To explore the level and associated factors of spiritual coping in patients with advanced colorectal cancer （CRC）, and to provide reference for instructing patients to positively cope with cancer. Methods A total of 212 patients with advanced CRC were investigated by using a general information questionnaire, the Spiritual Coping Questionnaire, Personal Mastery Scale, Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being, and the Existential Distress Scale. Results The sample scored 64.68±4.70 on positive spiritual coping and 12.07±3.03 on negative spiritual coping.Positive spiritual coping was po-sitively correlated with personal mastery and spiritual well-being, whereas negatively correlated with existential distress (all P＜0.05).Negative spiritual coping was negatively correlated with personal mastery and spiritual well-being, whereas positively correlated with existential distress (all P＜0.05).The results of multiple linear regression showed that religious belief, personal mastery, spiritual well-being and existential distress were the influencing factors of positive spiritual coping, accounting for 75.8% of the total variance.Disease stage, education level, personal mastery, spiritual well-being and existential distress were factors affecting negative spiritual coping, accounting for 71.0% of the total variance. Conclusion Patients with advanced CRC mostly use positive spiritual coping styles, while rarely use negative spiritual coping styles.It is suggested that medical staffs need to focus on implementing individualized spiritual care, alleviate patients′existential distress and improve their personal mastery and spiritual well-being, so as to boost positive coping with cancer.