Co-production as the ultimate goal; an incentive or discouragement?

Patient and public involvement (PPI) in research is a requirement in most of the western world. Funders routinely require extensive PPI plans from applicants and co-production is seen as the ultimate goal. The ladder of participation is unidimensional and does not account for the circumstances of the patients and their family members. Patients, especially those suffering from cancer, can be vulnerable and frail. Their disease and its unpredictable progression might prevent them from deep and lengthy involvement in research projects. Flexibility and adaptability is required from the research team to ensure that patients' are involved to the level they want and are able to. Consequently, co-production might not be feasible in certain cases. The impact of the involvement of contributors should be regarded in its own merit, taking into account their circumstances, even if co-production is not achieved.