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Background: Breast cancer patients often face the choice between breast-conserving surgery and mastectomy. From a shared decision-making perspective, it is crucial for patients to actively engage in the decision-making process, taking into account their own preferences and values. This approach can enhance treatment satisfaction and support the principles of precision nursing. Objective: To evaluate the level and classification of shared decision-making behavior in surgery, along with the influence of participation competence, perceived social support, and self-care self-efficacy, guided by the "Capacity, Opportunity, Motivation-Behavior" model. Method: A multicenter cross-sectional study was conducted in three hospitals in China from January 2021 to March 2022. The survey tools included self-designed demographic and clinical instrument, the Participation in Treatment Decision-Making Scale for cancer patients (PTDMS), the Participation Competence Scale (PCS), the Perceived Social Support Scale (PSSS), and the Strategies Used by People to Promote Health (SUPPH). Latent profile analysis was employed to assess the shared decision-making behavior in surgery. Multivariate logistic regression was applied to identify factors associated with the identified subtypes. Result: A total of 840 participants were ultimately analyzed. The best-fitting model identified three classes: active participation group (55.7%), moderate participation group (21.7%), and low participation group (22.6%). Logistic regression indicated that age, number of children, educational level, family income, employment status, cancer stage, type of surgery, participation competence, perceived social support, and self-care self-efficacy were main associated factors (all p < 0.05). Conclusion: The performance of shared decision-making behaviors in surgery needs improvement. This study may help nurses identify targeted intervention populations who are older, have more than three children, have a higher education level, have a lower family income, are employed, are at an advanced cancer stage, and are opting for mastectomy. It also emphasizes the importance of participation competence, social support, and self-care self-efficacy when designing intervention content.