Healthcare Professional Advocacy Practices to Promote Patient Safety: A Systematic Review

This systematic review aimed to synthesize qualitative and cross-sectional evidence describing how healthcare professionals (HCPs) apply patient advocacy (PA) practices to support patient safety and to inform strategies that strengthen patient safety through advocacy. A systematic literature search of CINAHL Complete and EBSCO MegaFILE was conducted on 26 September 2025, and PubMed was searched on 13 March 2026. Qualitative and cross-sectional studies meeting predefined eligibility criteria were included. Affinity mapping was used for thematic analysis, risk of bias was assessed using CASP checklists for qualitative research and for descriptive/cross-sectional studies, and certainty of evidence was assessed with GRADE-CERQual. Sixteen studies from 13 countries were included. Five interrelated themes described how HCPs advocated for patient safety: interprofessional collaboration, risk prevention, patient education and informed consent, safety-oriented advocacy behaviors, and medication management and polypharmacy. Across studies, advocacy practices involved collaborative decision-making, proactive risk mitigation, patient engagement through education and informed consent, safety-focused clinical prioritization, and vigilant medication management in complex care contexts. PA for safety is a multidimensional practice expressed through interconnected clinical, relational, and systems-level behaviors across healthcare settings. Recognizing advocacy as a core component of patient safety may guide the development of scalable, context-responsive interventions to support HCPs in safeguarding patients.