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The aim of this study is to examine whether the valuation of EQ-5D health states varies when framed within a palliative care needs\u00a0context: limited life expectancy and availability of supports. <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>This study was a multinational cross-sectional discrete choice experiment (DCE) with respondents from the general populations of Australia (<jats:italic>n<\/jats:italic>\u2009=\u20092,082), Ireland (<jats:italic>n<\/jats:italic>\u2009=\u20091,280), and the UK (<jats:italic>n<\/jats:italic>\u2009=\u20092,009). Each participant was presented with a series of 20 choice sets, in which they were asked to choose between two EQ-5D-5L health states and immediate death. Half of the choice sets were accompanied by a \u201ccontext vignette\u201d while the remaining half were \u201ccontext-free\u201d. The context vignettes, developed through a four-stage iterative process, described four distinct levels of palliative care needs. A D-efficient DCE design was developed, and the data were analysed using multinomial logit regression models. <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>The study found inconsistencies in the EQ-5D-5L health state valuations in palliative contexts compared with context free valuation. Both life expectancy and level of support impacted health state valuation, with life expectancy having the larger effect. The inclusion of the palliative care vignettes substantially increased the number of health states that were given values worse than dead. This increase was more pronounced in Australia and the UK than in Ireland.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>These results imply that EQ-5D value sets that are context free require careful interpretation, especially when applied in settings such as palliative care.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s11136-025-04023-9","type":"journal-article","created":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T09:18:59Z","timestamp":1753780739000},"page":"2865-2877","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Does context matter? 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To ensure an unbiased review process, the peer review and editorial decision for this manuscript were handled independently of the author, following the journal\u2019s standard procedures. The funding sources had no involvement in the study design, collection, analysis, and interpretation of data, writing, and decision to submit the article for publication.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study has been approved by the ethics committees at Trinity College Dublin [03E\/2021\/07 granted on 07 February 2022], Curtin University [HRE2022-0096 granted on 23 February 2022], University of Technology Sydney [HREC REF NO. ETH22-7049 granted on 12 April 2022], and King\u2019s College London [LRS-21\/22-29,058 granted on 02 September 2022].","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}