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A number of approaches have been developed for designing decision support systems for group work. However, emerging forms of dynamic and agile working patterns involving collaborations among mobile and cross-geographical individuals mean that group decision support systems should take into consideration the role and effect of context-awareness. This paper discusses the key challenges posed to systems design for e-collaborative work from the perspective of context-aware decision support. The paper argues that new systems design approaches are required to handle new decision support issues in emerging models of e-collaboration, and proposes a new approach for the design of context-aware decision support systems for e-collaboration in healthcare delivery.