Objective To explore the willingness, needs and influencing factors of shared decision-making participation in medication management among patients with rheumatic diseases and stakeholders, and to provide references for formulating effective SDM implementation strategies. Methods A descriptive phenomenological study design was adopted.Using purposive sampling,13 patients with rheumatic diseases, 8 caregivers, and 11 healthcare professionals were recruited for semi-structured interviews.Data were analyzed using thematic analysis. Results Four themes and nine sub-themes were identified:necessity for the implementation of shared decision-making (poor medication adherence resulting from insufficient communication and inadequate patient participation in decision-making, and the failure of medical staff to implement shared decision-making)；differentiation of multi-stakeholder willingness and neglect of patients′ decision-related needs (differences in participation willingness among doctors, nurses, patients, and caregivers,marginalization of patients′ and caregivers′ feelings and needs); facilitators of SDM implementation (positive advocacy role of organizational leadership,supportive role of family support resources);and barriers to SDM implementation (multiple constraints of clinical resources and environment,ambiguous role perception and unclear responsibility boundaries,healthcare professionals′ deep concerns about patient-provider conflicts). Conclusion SDM in rheumatology medication management faces multiple barriers. There is an urgent need to accelerate the development of clinically applicable decision aids and standardized procedures, establish mechanisms for rapid identification of decision preferences and family support assessment,and integrate emotional responses into communication quality evaluation,thereby promoting the in-depth implementation of SDM in clinical practice.