I don't share my passwords database. Right now my wife and I do have a very limited number of shared accounts but I set up the same system for her and we simply duplicate the few shared logins we have in our two databases. This could be an issue if we need to share more.
Creating new accounts is easy. Both my windows and iOS Keepass clients open the file directly from cloud storage. They can save changes and reload the database on startup. Once in a while I've had conflicting writes but it's rare, and I stopped getting them when I got better about saving and closing after changes.
Usage flow on PC (I'm sure I could install a browser extension, but haven't bothered yet):
1. oh I need a password. windows+s, type keepass, open keepass, type master password.
2. ctrl+e look for the website I'm on
3. ctrl+b copy username, paste
4. ctrl+c copy password, paste
Usage flow on iOS:
1. oh I need a password. iOS magically knows, gives me options of iCloud keychain or Keepass client. Select Keepass client
2. Sometimes it's not smart enough to detect which password entry to use. In this case, type in the website/app name and select it
3. Usually it's smart enough to fill out the username & password fields automatically