OBJECTIVES: To explore, from the perspective of patients with stable coronary artery disease (SCAD), their perspectives and experiences of shared decision-making (SDM) participation. DESIGN: A descriptive qualitative research design was adopted in this study. The reflexive thematic analysis method was used to generate themes. SETTING: The study was conducted at a grade III level A hospital in Hangzhou, Zhejiang Province, China. The main interview locations for this study were quiet wards, meeting rooms and the respondents' residences. PARTICIPANTS: Between January and April 2025, 15 patients with SCAD who met the inclusion and exclusion criteria were recruited and underwent semistructured interviews. RESULTS: This study developed three themes from the interviews: Theme 1: Specific content of participation in SDM, Theme 2: Family participation with Chinese characteristics, Theme 3: The complex game between ethics and efficiency. CONCLUSIONS: Healthcare providers can implement culturally sensitive, ethically informed sustainable development by guiding decision-making through gradual progression, valuing family hierarchy and advocating for better systemic support.