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.