On Fundamental Premises for Addressing "Context" and "Contextual Factors" Influencing Value Decisions in Healthcare Comment on "Contextual Factors Influencing Cost and Quality Decisions in Health and Care: A Structured Evidence Review and Narrative Synthesis".

In this commentary on Williams and colleagues' paper, I will address some essential issues related to research on contextual factors that influence value decision-making in healthcare. Based on the presumption that scientific work requires coherence in its ontological, epistemological and methodological approaches, I identify some challenges in their text and reflect on how those challenges might be addressed. I recommend that more normative work be done to make this a comprehensive area of research and suggest that the fundamental premises structuring investigations in this field be explicitly clarified.