Objective To explore the barriers and coping strategies in shared decision-making (SDM) within pediatric palliative care in China, and to advance the development and implementation of SDM interventions in pediatric palliative care field in China. Methods This research employed descriptive qualitative methods. Semi-structured, in-depth individual interviews were conducted with pediatric palliative care teams from 15 hospitals across 11 provinces, including 14 doctors, 7 nurses, and 6 social workers. The Ottawa Model of Research Use was utilized as both the theoretical framework and the analytical lens. The study analyzed barriers of SDM practice and coping strategies at three levels:practice environment, potential adopters, and evidence-based innovation. Results Barriers within the practice environment encompassed cultural, policy, knowledge system, and institutional dimensions. Potential adopters consisted of palliative care teams, parents, and children. Healthcare providers faced barriers due to a lack of relevant knowledge and skills, with the coping strategy being SDM training. Parents encountered barriers in engaging in SDM due to their understanding of the child′s condition, emotional challenges, and past SDM experiences; coping strategies included transpa-rently informing parents about the severity of the child′s condition, making decisions when they are emotionally stable, and providing tailored education. Barriers at the child level included a lack of illness awareness and constraints on decision-making ability based on age, cognitive level, and decision-making experience; coping strategies involved supporting families in discussing the illness and developing personalized decision-making models for children. Barriers at the evidence-based innovation level were related to the absence of support tools and structured intervention processes; coping strategies centered on creating localized support tools and intervention processes. Conclusion This study systematically analyzed the barriers to SDM practice from such 3 levels as practice environment, potential adopters, and evidence-based innovation and proposed targeted coping strategies. The findings provide a crucial theoretical foundation for enhancing SDM interventions in pediatric palliative care in China and offer practical guidance for healthcare providers engaged in SDM practice.