The treatment options for hernia have been becoming increasingly diverse. Coupled with the lack of high-quality clinical evidence and conflicts between the cognition and preferences of doctors and patients, a large number of “grey areas” in clinical decision-making have emerged. The traditional decision-making model is no longer suitable for clinical needs. Shared decision-making (SDM), a patient-centered decision-making model, provides an effective solution to this predicament. This article elaborates on the complexity of decision-making in hernia treatment, reviews the theoretical basis and SHARE implementation framework of SDM, summarizes its international evidence-based practices and application effects in hernia treatment, and at the same time analyzes the challenges faced by the implementation of SDM in the clinical practice of hernia and abdominal wall surgery in China, such as insufficient policy support, lack of training for medical staff, and the absence of localized decision-making support tools. It also proposes targeted coping strategies.