This cross-sectional study aimed to analyse the interaction willingness regarding empathy and self-disclosure among patients with malignant gynaecological tumours and their spouses and elucidate the underlying mechanisms.A total of 201 couples, each including one partner diagnosed with a malignant gynaecological tumour, were selected using a convenience sampling method between March 2023 and January 2024. Participants' general information, empathy capabilities, self-disclosure and support coping were assessed by a general information questionnaire, the Interpersonal Reactivity Index-C, the Distress Disclosure Index and the Couple Support Coping Scale, respectively.Both empathy and self-disclosure scores were significantly higher in the patients than in their spouses. Agent and object effect analyses showed that empathy in patients and their spouses could significantly positively predict their own self-disclosure and supportive coping abilities (p < 0.001). Furthermore, mediation effects indicated that spouses' empathy could influence patients' self-disclosure, albeit with a lower coefficient of 0.063, thereby enhancing the perceived effectiveness of spousal support coping. All these effects are statistically significant (p < 0.001).The capabilities of self-disclosure and empathy in patients with malignant gynaecological tumours and their spouses are closely associated with spousal support coping. Therefore, interventions should be crafted from a dyadic perspective to enhance both partners' empathic abilities and self-disclosure skills, thereby promoting mutual support and coping capabilities.