The role of job satisfaction on the association between perceived person-centred care and stress of conscience: a moderated mediation analysis of cross-sectional data from primary care professionals

Primary care professionals play a crucial role in promoting public health, yet they often face challenging work environments characterised by stress of conscience, described as distress felt when external constraints or conflicting responsibilities prevent healthcare professionals from acting in line with their ethical beliefs. Introducing more person-centred care (PCC) could increase job satisfaction and mitigate these challenges. This study aimed to determine the association between perceived PCC and the experience of stress of conscience among primary care professionals and whether this association is mediated by job satisfaction and moderated by profession. A cross-sectional survey methodology was employed, involving various primary care professionals in western Sweden. Of the 944 completed questionnaires (21.3% response rate), 562 were included in the analysis based on specific criteria. The questionnaire measured their perceived PCC, job satisfaction, type of profession, and stress of conscience. Statistical analyses, including mediation analysis and moderated mediation analysis, were performed. The findings show that perception of more PCC was significantly associated with lower levels of stress of conscience. Furthermore, mediation analysis revealed that job satisfaction partially mediated the relationship between perceived PCC and stress of conscience. Our study found that approximately 29% of the total effect of perceived PCC on stress of conscience was transmitted through job satisfaction. Including the type of profession as a moderator led to a decrease in the mediated association between perceived PCC and stress of conscience (B = -1.443 to B = -0.786). This study showed that perceived PCC was directly associated with stress of conscience in primary care settings, with job satisfaction partially mediating this association. Future studies should consider job satisfaction as a mediating factor and explore the impact of professional variation on the PCC adoption and effectiveness.