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Purpose: To investigate the preferred and actual participation levels of colorectal cancer patients and their families in treatment decision-making. Methods: A cross-sectional survey was conducted using a questionnaire administered to colorectal cancer patients hospitalized in the general surgical wards in two of the upper first-class hospitals in Beijing between February and July 2013. Results: A total of 113 questionnaires were analyzed. For the families of colorectal cancer patients, the concordance rate of their preferred and actual participation levels in treatment decision-making was 60.2% and 62.8% for the patients themselves. Patients with stoma and male patients preferred a passive role compared to those without stoma and female patients (x2 = 7.978, p < 0.05; x2 = 9.854, p < 0.05). Conclusions: Over 40% of colorectal cancer patients preferred a passive role in treatment decision-making. We suggest that communication between physicians and patients should be strengthened to accommodate the patient's desired level of involvement.