Background <p>Shared decision-making (SDM) improves outcomes in urinary reconstruction after radical cystectomy, but its implementation in China remains understudied. This qualitative study explores SDM barriers and facilitators from patient and provider perspectives.</p> Methods <p>This study employed purposive sampling to recruit healthcare professionals and patients undergoing radical cystectomy from a single tertiary hospital. A qualitative approach involving semi-structured interviews was used to capture participants’ perspectives. Thematic analysis was applied to identify key themes and subthemes.</p> Results <p>A total of 11 healthcare professionals and 15 patients with bladder cancer participated. Thematic analysis identified 4 main themes and 15 subthemes. (1) Decision autonomy and experience: encompassing patients’ participation levels, confidence, and anxiety, and providers’ attention to patient trust and preferences. (2) Information acquisition and understanding: including patients’ information sources and comprehension abilities; and methods used by healthcare professionals to communicate medical information. (3) Professional expertise and occupational burden: exploring patients’ perceptions of doctors’ authority and skills; with role strain and emotional challenges faced by providers. (4) Social security and education: addressing gaps in health literacy; protection of patient rights; and inadequacies in SDM-related education.</p> Conclusions <p>SDM in China is limited by systemic challenges, including health literacy deficits, clinician workload, and policy gaps. Targeted interventions such as patient education, communication training, and policy reforms are needed to enhance collaborative decision-making.</p>