Caught Between Two Silences

Abstract

Sexuality and intimacy remain important aspects of quality of life in the context of incurable cancer and palliative care, yet they are often difficult to address within healthcare practice and intimate relationships. People with incurable cancer and their partners experience changes in intimacy, communication, and relational balance, while support for these experiences is often limited or primarily medically oriented. This graduation project explores how design can sensitively support sexual well-being in palliative care.

The project was conducted as part of a broader research initiative at Erasmus Medical Center and focused on translating qualitative research insights into a concrete design concept. A combination of design research methods and qualitative healthcare research approaches, including literature review and in-depth interviews, was used to explore the problem space.

The research identified two central relational mechanisms: autonomy and communication. Partners often struggle to express personal needs without guilt, while communication about intimacy becomes challenging due to emotional burden and shifting relational roles. These insights informed the formulation of design opportunities and guided a broad exploration of possible design directions.

Through a structured selection process, one concept direction was chosen for further development: the Pillow Partner. This concept consists of a pair of connected pillows that allow partners to record and listen to intimate voice messages. It aims to support autonomy by enabling control over timing and emotional exposure, and to support communication by offering an indirect and less confrontational medium for sharing sensitive thoughts.

The concept was refined through expert interviews and exploratory user interviews, which provided insights into emotional impact, usability, and contextual sensitivity. Key findings emphasized the importance of a warm, non-medical and gender-neutral design, physical comfort, and a sense of connection, while also revealing tensions between autonomy, simplicity, and relational responsibility.

Finally, implementation considerations were explored, focusing on low-threshold introduction, discretion, privacy, and the supportive role of healthcare professionals. Rather than presenting a final solution, this project offers a grounded design concept and strategic directions for further development. It demonstrates how design can meaningfully contribute to supporting communication and autonomy in intimate relationships affected by incurable illness, while acknowledging the ethical and emotional complexity of this domain.