Mailed FIT Implementation Guide

The Mailed FIT Implementation Guide and the Mailed FIT Online Course have been developed to help improve colorectal cancer screening rates in diverse healthcare settings.

The Mailed FIT Implementation Guide provides a roadmap for how health systems and other health entities can design and carry out mailed fecal immunochemical test (FIT) outreach programs. The Guide was created by the National Association of Chronic Disease Directors (NACDD) in partnership with the Kaiser Permanente Center for Health Research (KPCHR) and with the support of the Centers for Disease Prevention and Control (CDC).

The goal of the Mailed FIT Implementation Guide is to provide administrators and staff with the information needed to make informed decisions and successfully implement an outreach program. The Guide details the process for planning and implementing a mailed FIT outreach program by addressing the following process steps: Prerequisites (Key Partnerships, Capacity, Technical Resources), Getting Ready, Selecting a FIT Kit, Executing a Mailed FIT Outreach Program, Following Up on Abnormal Test Results, and Sustaining the Program. Two chapters containing Resources and References are also included.

The Mailed FIT Online Course is the newest resource and was developed based on the components of the Mailed FIT Implementation Guide. The course is a free, self-paced online program for busy health professionals that provides easy-to-access information in video format. Ten videos narrated by subject matter experts from around the nation cover all components of a mailed FIT outreach program. Three testimonial videos from experienced clinics describe their tips and strategies for implementing a successful mailed FIT outreach program. Finally, a helpful companion notebook for the course gives step-by-step activities and checklists for gathering and organizing the information needed to establish an outreach program. The Mailed FIT Online Course was created by NACDD in partnership with KPCHR and with the support of the CDC.

Evaluation: The evidence provided in the Mailed FIT Implementation Guide and subsequently created Mailed FIT Online Course was based on two primary sources. The first source was the five-year STOP CRC trial of mailed FIT outreach programs in 26 federally qualified health centers in Oregon and California (2013-2018). The trial investigated whether the use of mailed FIT outreach programs with follow-up colonoscopy for abnormal FIT results could increase CRC screening rates above the rates obtained with usual care opportunistic screening. The findings showed a significant improvement in CRC screening rates and an overall FIT return rate of 21%. The second source of evidence was the 2019 Mailed FIT Summit, which was sponsored by the CDC and hosted by the NACDD. The Summit participants included subject matter experts and stakeholders from across the nation. An accompanying journal article published in CA: A Cancer Journal for Clinicians described the Summit’s goals, process, and findings in detail.

Permissions: Made publicly available online by the National Association of Chronic Disease Directors.

Publication date: Guide published October 2021, last revised June 14, 2022; Online Course published March 2023. 

Post date: August 22, 2022, updated August 2023. 

Contact: Please send comments or questions to Lorrie Graaf ( or Dawn Wiatrek (