Background
 
Patient and Public Involvement and Engagement (PPIE) is increasingly recognised as a core component of high-quality health research. It enhances relevance, feasibility, and accountability by incorporating lived experience into research design and implementation. While PPIE has been widely institutionalised in several high-income countries, its systematic adoption remains limited in low- and middle-income countries (LMICs), including India. Indian health research has historically operated within a hierarchical, clinician-led framework, with limited opportunities for patients to influence research priorities or the development of interventions. This gap is also salient in cancer survivorship research, where long-term outcomes, daily functioning, and quality of life are shaped by lived experience beyond biomedical indicators. Nutritional interventions following gastric cancer surgery represent a context in which patient perspectives are especially critical, given the complex, culturally embedded nature of dietary practices and post-surgical symptom burden.
 
Objectives
This paper illustrates our experiences with the PPIE implementation process, as well as the utility of this tool for supporting the development of a patient-centred dietary intervention for  individuals with total gastrectomy post gastric cancer in Indian settings
Methods
PPIE was embedded within the EASE-IN study through a two-stage, iterative engagement process involving individuals with gastric cancer who had undergone total gastrectomy within the previous year. PPIE Contributors (participants) were selected using predefined criteria, including recent surgical experience, access to online communication platforms (directly or via relatives), and efforts to ensure gender balance. Two virtual PPIE meetings were conducted via an online platform (September 2024 and June 2025).
The first meeting focused on eliciting patients’ experiences regarding diet, symptom management, lifestyle adaptation, and access to nutritional support. Insights were synthesised alongside global and national evidence to draft dietary recommendations. In the second meeting, contributors reviewed and validated these recommendations, providing feedback on feasibility, cultural relevance, and acceptability. Roles were clearly delineated: a research fellow coordinated recruitment, documentation, and synthesis, while a clinical dietitian moderated discussions and facilitated interpretation of patient input.
 
Results
 
PPIE contributors provided detailed insights into post-gastrectomy dietary challenges, including food intolerance, early satiety, symptom-driven food avoidance, and the need for flexible, phased dietary guidance. They provided local dietary preferences, which helped us synchronise our intervention with local food culture. Their input directly informed refinement of dietary recommendations, including meal frequency, food consistency, and symptom-specific strategies.
 
Conclusions
This study demonstrates that structured PPIE is feasible and methodologically valuable within Indian cancer research. Patient perspectives enhanced the contextual relevance and acceptability of a dietary intervention. Cancer and nutritional research represent strategic entry points for advancing PPIE in India. Institutionalising PPIE through funder requirements, ethics review processes, and researcher training is essential to move beyond isolated examples toward routine, patient-centred cancer research in LMICs. Experiences from our study would be a learning for future studies in similar settings.